Automatic segmentation and annotation in radiology - Dankerl, Peter; Uder, Michael; Hammon, Matthias; Cavallaro, Alexander Josef (Radiologe, 2014)
The technical progress and broader indications for cross-sectional imaging continuously increase the number of radiological images to be assessed. However, as the amount of image information and available resources (radiologists) do not increase at the same pace and the standards of radiological interpretation and reporting remain consistently high, radiologists have to rely on computer-based support systems. Novel semantic technologies and software relying on structured ontological knowledge are able to "understand" text and image information and interconnect both. This allows complex database queries with both the input of text and image information to be accomplished. Furthermore, semantic software in combination with automatic detection and segmentation of organs and body regions facilitates personalized supportive information in topographical accordance and generates additional information, such as organ volumes. These technologies promise improvements in workflow; however, great efforts and close cooperation between developers and users still lie ahead.
EVALuna2:14374

Automatic Segmentation of the Optic Radiation using DTI in Glaucoma Patients - El-Rafei, Ahmed Mohamed Ibrahim; Hornegger, Joachim; Engelhorn, Tobias; Dörfler, Arnd; Wärntges, Simone; Michelson, Georg (Computational Vision and Medical Image Processing - VipIMAGE 2009, 2009)

Automatic Segmentation of the Optic Radiation Using DTI in Healthy Subjects and Patients with Glaucoma - El-Rafei, Ahmed Mohamed Ibrahim; Engelhorn, Tobias; Wärntges, Simone; Dörfler, Arnd; Hornegger, Joachim; Michelson, Georg (Computational Vision and Medical Image Processing, 2011)

Automatic sub-volume registration by probabilistic random search - Han, Jingfeng; Qiao, Min; Hornegger, Joachim; Kuwert, Torsten; Bautz, Werner; Römer, Wolfgang (Medical Imaging 2006: Image Processing, 2006)
Registration of an individual's image data set to an anatomical atlas provides valuable information to the physician. In many cases, the individual image data sets are partial data, which may be mapped to one part or one organ of the entire atlas data. Most of the existing intensity based image registration approaches are designed to align images of the entire view. When they are applied to the registration with partial data, a manual pre-registration is usually required. This paper proposes a fully automatic approach to the registration of the incomplete image data to an anatomical atlas. The spatial transformations are modelled as any parametric functions. The proposed method is built upon a random search mechanism, which allows to find the optimal transformation randomly and globally even when the initialization is not ideal. It works more reliably than the existing methods for the partial data registration because it successfully overcomes the local optimum problem. With appropriate similarity measures, this framework is applicable to both mono-modal and multi-modal registration problems with partial data. The contribution of this work is the description of the mathematical framework of the proposed algorithm and the implementation of the related software. The medical evaluation on the MRI data and the comparison of the proposed method with different existing registration methods show the feasibility and superiority of the proposed method.

A web based cross-platform application for teleconsultation in radiology - Kammerer, Ferdinand J.; Hammon, Matthias; Schlechtweg, Philipp; Uder, Michael; Schwab, Siegfried (Journal of Telemedicine and Telecare, 2015)
The growing complexity of radiologic examinations and interventional procedures requires frequent exchange of knowledge. Consequently a simple way to share and discuss patient images between radiology experts and with colleagues from other medical disciplines is needed. Aims of this work were the development and initial performance evaluation of a fast and user friendly, platform independent teleconsultation system for medical imaging. A local back end system receives DICOM images and generates anonymized JPEG files that are uploaded to an internet webserver. The front end running on that webserver comprises an image viewer with a specially developed pointer element for indicating findings to collaborative partners. The front end that uses only standard web technologies works on a variety of different platforms, mobile devices and desktop computers. Images can be accessed by simply calling up a special internet address in a web browser that may be exchanged between users (e.g. via email). A speed evaluation of the system showed good results: For example the preparation and upload of a standard head CT took less than 21 seconds. The data volume of the same series and the viewer application could be transferred to a mobile phone in less than 42 seconds via a UMTS network or in less than 3 seconds via a HSPA network. The presented system with its minimal hard- and software requirements, its simplicity and platform independence might be a promising tool in the increasingly important area of teleconsultation.
EVALuna2:14496

A workflow for patient-individualized virtual angiogram generation based on CFD simulation - Endres, Jürgen; Kowarschik, Markus; Redel, Thomas; Sharma, Puneet; Mihalef, Viorel; Hornegger, Joachim; Dörfler, Arnd (Computational and Mathematical Methods in Medicine, 2012)

Baseline magnetic resonance imaging of the optic nerve provides limited predictive information on short-term recovery after acute optic neuritis - Berg, Sebastian; Kaschka, Iris; Utz, Kathrin S.; Huhn, Konstantin; Laemmer, Alexandra; Lämmer, Robert; Waschbisch, Anne; Kloska, Stephan; Lee, De-Hyung; Dörfler, Arnd; Linker, Ralf (PLoS ONE, 2015)
In acute optic neuritis, magnetic resonance imaging (MRI) may help to confirm the diagnosis as well as to exclude alternative diagnoses. Yet, little is known on the value of optic nerve imaging for predicting clinical symptoms or therapeutic outcome.To evaluate the benefit of optic nerve MRI for predicting response to appropriate therapy and recovery of visual acuity.Clinical data as well as visual evoked potentials (VEP) and MRI results of 104 patients, who were treated at the Department of Neurology with clinically definite optic neuritis between December 2010 and September 2012 were retrospectively reviewed including a follow up within 14 days.Both length of the Gd enhancing lesion (r = -0.38; p = 0.001) and the T2 lesion (r = -0.25; p = 0.03) of the optic nerve in acute optic neuritis showed a medium correlation with visual acuity after treatment. Although visual acuity pre-treatment was little but nonsignificantly lower if Gd enhancement of the optic nerve was detected via orbital MRI, improvement of visual acuity after adequate therapy was significantly better (0.40 vs. 0.24; p = 0.04). Intraorbitally located Gd enhancing lesions were associated with worse visual improvement compared to canalicular, intracranial and chiasmal lesions (0.35 vs. 0.54; p = 0.02).Orbital MRI is a broadly available, valuable tool for predicting the improvement of visual function. While the accurate individual prediction of long-term outcomes after appropriate therapy still remains difficult, lesion length of Gd enhancement and T2 lesion contribute to its prediction and a better short-term visual outcome may be associated with detection and localization of Gd enhancement along the optic nerve.
EVALuna2:21236

Baseline radiographic osteoarthritis and semi-quantitatively assessed meniscal damage and extrusion and cartilage damage on MRI is related to quantitatively defined cartilage thickness loss in knee osteoarthritis: the Multicenter Osteoarthritis Study - Guermazi, A.; Eckstein, F.; Hayashi, D.; Roemer, Frank; Wirth, Wolfgang; Yang, T.; Niu, J.; Sharma, L.; Nevitt, M. C.; Lewis, C. E.; Torner, J.; Felson, D. T. (Osteoarthritis and Cartilage, 2015)
To provide a comprehensive simultaneous relation of various semiquantitative knee OA MRI features as well as the presence of baseline radiographic osteoarthritis (OA) to quantitative longitudinal cartilage loss.We studied Multicenter OA Study (MOST) participants from a longitudinal observational study that included quantitative MRI measurement of cartilage thickness. These subjects also had Whole Organ MRI Score (WORMS) scoring of cartilage damage, bone marrow lesions (BMLs), meniscal pathology, and synovitis, as well as baseline radiographic evaluation for Kellgren and Lawrence (KL) grading. Knee compartments were classified as progressors when exceeding thresholds of measurement variability in normal knees. All potential risk factors of cartilage loss were dichotomized into "present" (score >=2 for cartilage, >=1 for others) or "absent". Differences in baseline scores of ipsi-compartmental risk factors were compared between progressor and non-progressor knees by multivariable logistic regression, adjusting for age, sex, body mass index, alignment axis (degrees) and baseline KL grade. Odds ratios (OR) and 95% CIs were calculated for medial femorotibial compartment (MFTC) and lateral femorotibial compartment (LFTC) cartilage loss. Cartilage loss across both compartments was studied using Generalized Estimating Equations.196 knees of 196 participants were included (age 59.8 ± 6.3 years [mean ± SD], BMI 29.5 ± 4.6, 62% women). For combined analyses of MFTC and LFTC, baseline factors related to cartilage loss were radiographic OA (KL grade >=2: aOR 4.8 [2.4-9.5], cartilage damage (aOR 2.3 [1.2-4.4])), meniscal damage (aOR 3.9 [2.1-7.4]) and extrusion (aOR 2.9 [1.6-5.3]), all in the ipsilateral compartment, but not BMLs or synovitis.Baseline radiographic OA and semiquantitatively (SQ) assessed MRI-detected cartilage damage, meniscal damage and extrusion, but not BMLs or synovitis is related to quantitatively measured ipsi-compartmental cartilage thinning over 30 months.
EVALuna2:14531

Baseline structural tissue pathology is not strongly associated with longitudinal change in transverse relaxation time (T2) in knees without osteoarthritis - Roemer, Frank; Eckstein, Felix; Duda, Georg N.; Guermazi, Ali; Maschek, Susanne; Wirth, Wolfgang (European Journal of Radiology, 2019)
Purpose: To evaluate whether baseline MRI-defined structural abnormalities are associated with subsequent change in laminar femorotibial cartilage transverse relaxation time (T2) of participants without radiographic signs, symptoms or risk factors for knee osteoarthritis (OA). Method: We studied all right knees with longitudinal MRI data of the refined Osteoarthritis Initiative Healthy Reference cohort. Baseline osteophytes, effusion-synovitis, Hoffa-synovitis, bone marrow lesions, cartilage lesions, and meniscus morphology and - extrusion were scored semiquantitatively from MR images by an expert reader. Deep and superficial layer cartilage T2 was computed in the medial and lateral femorotibial compartment (MFTC/LFTC) at baseline and at 1- and 4-year follow-up from multi-echo spin-echo MR images. Statistical analyses were performed using UNIANOVA. Results: 82 participants (age 54.1 ± 7.2y, BMI 24.2 ± 3.0 kg/m²; 61% women, bilateral Kellgren-Lawrence 0) were studied. Number of baseline MRI pathologies was not significantly associated with longitudinal change in MFTC or LFTC cartilage T2 over 1 or 4 years. Feature-specific analyses suggested that presence of baseline MFTC osteophytes may be associated with prolongation in superficial MFTC cartilage T2 over one (0.8 vs. 0.0 ms, p = 0.02) and four years (2.3 vs. 0.9 ms, p = 0.01), and that MFTC meniscal damage or extrusion may be associated with prolongation in deep layer T2 times over the first year (0.7 vs. 2.1 ms, p = 0.02). Conclusions: Our study does not provide evidence that, in knees without radiographic OA, baseline structural MRI abnormalities are strongly related to compositional progression during normal aging and/or the potentially earliest phases of the disease as measured by cartilage T2.
CRIS-Team Scopus Importer:2019-08-06
Keywords: MRI; Osteoarthritis; Prediction; T2

BASELINE VALUES AND CHANGE IN SUPERFICIAL AND DEEP LAYER CARTILAGE T2 TIMES IN EXTERNAL FEMORAL SUBREGIONS DO NOT DIFFER BETWEEN KNEES WITH AND WITHOUT OSTEOPHYTES - DATA FROM THE OSTEOARTHRITIS INITIATIVE - Wirth, W.; Maschek, S.; Roemer, Frank; Eckstein, F. (2017)
EVALuna2:36274

Bedside Catheter Hematoma Evacuation in Vitamin K Antagonist-Related Intracerebral Hemorrhage: A Safe and Feasible Approach - Volbers, Bastian; Niesen, Wolf Dirk; Amiri-Soltani, Samuel; Staykov, Dimitre; Shah, Mukesch Johannes; Lang, Stefan; Lücking, Hannes; Kuramatsu, Joji; Huttner, Hagen; Schwab, Stefan; Bardutzky, Jürgen (Frontiers in Neurology, 2020)
Background and Purpose: Although outcome in intracerebral hemorrhage (ICH) patients is generally not improved by surgical intervention, the use of minimally invasive surgery (MIS) has shown promising results. However, vitamin K antagonist (VKA)-related ICH patients are underrepresented in surgical treatment trials. We therefore assessed the safety and efficacy of a bedside MIS approach including local application of urokinase in VKA-related ICH. Methods: Patients with a VKA-related ICH > 20 ml who received bedside hematoma evacuation treatment (n = 21) at the University Medical Center Freiburg were retrospectively included for analysis and compared to a historical control group (n = 35) selected from an institutional database (University Medical Center Erlangen) according to identical inclusion criteria. Propensity score matching was performed to obtain comparable cohorts. The evolution of hematoma and peri-hemorrhagic edema (PHE) volumes, midline shift, and the occurrence of adverse events were analyzed. Furthermore, we assessed the modified Rankin Scale and NIHSS scores recorded at discharge. Results: Propensity score matching resulted in 16 patients per group with well-balanced characteristics. Median ICH volume at admission was 45.7 (IQR: 24.2–56.7) ml in the control group and 48.4 (IQR: 28.7–59.6) ml in the treatment group (p = 0.327). ICH volume at day 7 was less pronounced in the treatment group [MIS: 23.2 ml (IQR: 15.8–32.3) vs. control: 43.2 ml (IQR: 27.5–52.4); p = 0.013], as was the increase in midline shift up to day 7 [MIS: −3.75 mM (IQR: −4.25 to −2) vs. control: 1 mM (IQR: 0–2); p < 0.001]. No group differences were observed in PHE volume on day 7 [MIS: 42.4 ml (IQR: 25.0–72.3) vs. control: 31.0 ml (IQR: 18.8–53.8); p = 0.274] or mRS at discharge [MIS: 5 (IQR: 4–5) and 5 (IQR: 4–5); p = 0.949]. No hematoma expansion was observed. The catheter had to be replaced in 1 patient (6%). Conclusions: Bedside catheter-based hematoma evacuation followed by local thrombolysis with urokinase appears to be feasible and safe in cases of large VKA-related ICH. Further studies that assess the functional outcome associated with this technique are warranted. Clinical Trial Registration: DRKS00007908 (German Clinical Trial Register; www.drks.de).
CRIS-Team Scopus Importer:2020-09-11
Keywords: intracerebral hemorrhage; midline shift; minimally invasive surgery; peri-hemorrhagic edema; vitamin K antagonist

Begleitwort zum Curriculum für die Facharztausbildung und die Weiterbildung in der Muskuloskelettalen Radiologie - Braunschweig, Rainer; Janka, Rolf Matthias; Regier, Marc (Radiologe, 2020)
CRIS-Team Scopus Importer:2020-04-28

Benefits of Long Versus Short Thrombolysis Times for Acutely Thrombosed Hemodialysis Native Fistulas - Regus, Susanne; Lang, Werner; Heinz, Marco; Uder, Michael; Schmid, Axel (Vascular and Endovascular Surgery, 2017)
Local thrombolysis with a time of exposure to recombinant tissue plasminogen activator of 15 to 150 minutes is commonly used to declot acutely thrombosed hemodialysis fistulas. The duration of thrombolysis for the restoration of arteriovenous blood flow remains controversial. The aim of this study was to investigate the outcomes of long thrombolysis treatment (LTT, 3 hours or more) and short thrombolysis treatment (STT, less than 3 hours) in our institution.We retrospectively analyzed 86 interventional declotting procedures (28 STT and 58 LTT) applied to 86 acutely thrombosed hemodialysis fistulas. The intervention time (IT) following thrombolysis (from the initial fistulography to the end of the angioplasty maneuvers), the time of day of the intervention (ie, during working hours vs off-hours), and the need for temporary catheter placement (TCP) were assessed. Success was defined as complete access recanalization, and major adverse events were defined as ischemia, bleeding, and access rupture.The ITs were reduced after LTT (63.3 [9.3] minutes) compared to STT (106.7 [24.7], P = .01), but there was no difference in success rate (85.7% STT, 89.7% LTT, P = .722). While all (100%, 58/58) of the angioplasty maneuvers after LTT were performed during regular working hours, 75% (21/28) of those following STT were managed during off-hours ( P < .001). Despite the longer treatment, the need for TCP was not increased after LTT (10.7%) compared to STT (12.1%, P = .515), and the major complication rate was reduced (3.4% after LTT and 28.6% after STT, P = .004).Long thrombolysis treatment results in shorter and less complicated percutaneous stenosis treatments during regular working hours. Despite the LTT of up to 25 hours until access for dialysis was achieved, no increase in the risks of TCP or major adverse events were observed following LTT.
EVALuna2:14643

Beyond Functional Impairment: Redefining Favorable Outcome in Patients with Subarachnoid Hemorrhage - Custal, Christina; Koehn, Julia; Borutta, Matthias; Mrochen, Anne; Brandner, Sebastian; Eyupoglu, Ilker Y.; Lücking, Hannes; Hölter, Philip; Kuramatsu, Joji; Kornhuber, Johannes; Schwab, Stefan; Huttner, Hagen; et al. (Cerebrovascular Diseases, 2021)
Background: For outcome assessment in patients surviving subarachnoid hemorrhage (SAH), the modified Rankin scale (mRS) represents the mostly established outcome tool, whereas other dimensions of outcome such as mood disorders and impairments in social life remain unattended so far. Objective: The aim of our study was to correlate 12-month functional and subjective health outcomes in SAH survivors. Methods: All SAH patients treated over a 5-year period received outcome assessment at 12 months, including functional scores (mRS and Barthel Index [BI]), subjective health measurement (EQ-5D), and whether they returned to work. Analyses - including utility-weighted mRS - were conducted to detect associations and correlations among different outcome measures, especially in patients achieving good functional outcome (i.e., mRS 0-2) at 12 months. Results: Of 351 SAH survivors, 287 (81.2%) achieved favorable functional outcome at 12 months. Contrary to the BI, the EQ-5D visual analog scale (VAS) showed a strong association with different mRS grades, accentuated in patients with favorable functional outcome. Despite favorable functional outcome, patients reported a high rate of impairments in activities (24.0%), pain (33.4%), and anxiety/depression (42.5%). Further, multivariable analysis revealed (i) impairments in activities (odds ratio [OR] [95% confidence interval CI]: 0.872 [0.817-0.930]), (ii) presence of depression or anxiety (OR [95% CI]: 0.836 [0.760-0.920]), and (iii) return to work (OR [95% CI]: 1.102 [0.1.013-1.198]) to be independently associated with self-reported subjective health. Conclusion: Established stroke scores mainly focusing on functional outcomes do poorly reflect the high rate of subjective impairments reported in SAH survivors, specifically in those achieving good functional outcome. Further studies are needed to investigate whether psychoeducational approaches aiming at improving coping mechanisms and perceived self-efficacy may result in higher subjective health in these patients.
CRIS-Team WoS Importer:2021-08-06

Bioabsorbable Unsintered Hydroxyapatite/Poly-l-Lactic Acid Pin Fixation of Osteochondritis Dissecans in Adolescents: Initial Experiences - Zeilinger, Martin Georg; Autenrieth, Christian; Remmel, Kerstin; Schuh, Alexander; Hammon, Matthias; Schraml, Annemarie; Uder, Michael; Rompel, Oliver (Zeitschrift für Orthopädie und Unfallchirurgie, 2020)
Background This study sought to retrospectively evaluate the clinical and magnetic resonance imaging (MRI) outcomes of u-HA/PLLA pin (u-HA/PLLA: hydroxyapatite/poly-L-lactic acid) pin fixation of unstable osteochondritis dissecans (OCD) lesions of the knee. Methods Seven adolescent patients (four females and three males) with arthroscopically unstable OCD lesions of the knee were included. The mean age at diagnosis was 13.1 years. Clinical results were evaluated preoperatively and during follow-up using the Ogilvie-Harris score (0-15 points). MRI scans were performed preoperatively and during follow-up, with results evaluated using the Dipaola classification (grades 1-4). Mean follow-up time was 29 months. Results The median Ogilvie-Harris score improved from 13 points (range: 10-14 points) to 15 points (range: 13-15 points). Separately, the median Dipaola score improved from 3 points (range: 2-4 points) to 1 point (range: 1-4 points). No complications such as infection, synovitis, or intra-articular adhesion were observed. Conclusions Initial experiences using bioabsorbable u-HA/PLLA pins for the refixation of unstable OCD lesions in adolescents in the knee are promising, and MRI provides excellent monitoring of healing.
CRIS-Team Scopus Importer:2020-12-25
Keywords: bioabsorbable pins; juvenile; Osteochondritis dissecans; u-HA/PLLA

Biochemical cartilage changes based on MRI-defined T2 relaxation times do not equal OA detection - Roemer, Frank; Guermazi, Ali (Proceedings of the National Academy of Sciences of the United States of America, 2021)
CRIS-Team Scopus Importer:2021-03-19

Biochemical markers of neurodegeneration in hereditary diffuse leucoencephalopathy with spheroids - Spitzer, Philipp; Kohl, Zacharias; Gölitz, Philipp; Coras, Roland; Blümcke, Ingmar; Brueck, Wolfgang; Dörfler, Arnd; Maihöfner, Christian (BMJ Case Reports, 2014)
Hereditary diffuse leucoencephalopathy with spheroids (HDLS) is a rare autosomal dominantly inherited disease with unknown pathophysiology. Diagnosis of neurodegenerative diseases is increasingly based on biomarkers. Although lumbar puncture is routinely performed during the diagnostic workup of HDLS, reports on alterations of neurodegeneration-specific biochemical markers have not been documented so far. We report a 35-year-old woman with clinical, radiological and neuropathological signs of HDLS. She suffered from a rapidly progressive frontal lobe syndrome. Brain MRI revealed diffuse leucoencephalopathy with predominant involvement of the periventricular white matter and corpus callosum. Although she was severely impaired and leucoencephalopathy was prominent, only cerebrospinal fluid total-? was moderately elevated. Other markers of neuronal (NSE) and astrocytic (S100B) damage were within normal range. Therefore, biochemical markers of central nervous system damage are not helpful in the diagnosis of HDL
EVALuna2:7264

Biochemische Knorpeldiagnostik – Update 2019 - Trattnig, S.; Raudner, M.; Schreiner, M.; Roemer, Frank; Bohndorf, K. (Radiologe, 2019)
Background: Cartilage imaging using magnetic resonance imaging (MRI) is increasingly used for early detection of cartilage damage. Biochemical MR methods to assess cartilage damage are essential for optimal treatment planning. Purpose: The aim of this review is to provide an update on advanced cartilage imaging based on biochemical MR techniques. The clinical applications and additional benefits compared to conventional MRI are presented. Materials and methods: A literature search of PubMed regarding the clinical applications of various biochemical MR methods and morphological MR imaging was performed. Results: While T2 mapping can be easily implemented on clinical routine MR scanners, the T1rho method is technically more demanding and is not available on all MR scanners. dGEMRIC, which can be performed with all field strengths, is now severely restricted due to the recent decision of the European Medical Agency (EMA) to withdraw linear gadolinium contrast agents from the market because of proven gadolinium deposition in the brain. Sodium imaging is the most sensitive MRI method for glycosaminoglycan (GAG), but is limited to 7 T. In addition to early diagnosis of cartilage degeneration before morphological changes are visible, biochemical MRI offers predictive markers, e.g., effect of lifestyle changes or assessing results of cartilage repair surgery. Conclusion: Cartilage imaging based on biochemical MRI allows a shift from qualitative to quantitative MRI. Biochemical MRI plays an increasingly important role in the early diagnosis of cartilage degeneration for monitoring of disease-modifying drugs and as predictive imaging biomarker in clinical diagnostics. In cartilage repair, monitoring of the efficacy of different cartilage repair surgery techniques to develop hyaline-like cartilage can be performed with biochemical MRI.
CRIS-Team Scopus Importer:2019-06-21
Keywords: Arthritis; Contrast media; Glycosaminoglycan; Knee joint; Magnetic resonance imaging

Biomechanical knee cartilage analysis in young professional soccer players by a T2 mapping unloading algorithm - Welsch, Götz; Waldenmeier, L; Evers, C; Janka, Rolf Matthias; Uder, Michael; Hennig, Friedrich; Lochmann, Matthias (Osteoarthritis and Cartilage, 2014)

Bisphosphonates intake and its association with changes of periarticular bone area and three-dimensional shape: data from the Osteoarthritis Initiative (OAI) - Haj-Mirzaian, A.; Guermazi, Ali; Roemer, Frank; Bowes, M. A.; Conaghan, P. G.; Demehri, S. (Osteoarthritis and Cartilage, 2018)
OBJECTIVE: To determine the association between bisphosphonate treatment with the change of periarticular bone area and three-dimensional (3D) shape in participants of the Osteoarthritis Initiative (OAI) study. DESIGN: Using propensity score (PS) matching method in females, 48 bisphosphonate users and 105 non-users, who were matched for osteoarthritis (OA) and osteoporosis (OP) related factors were included. Baseline and 24-month magnetic resonance imaging (MRI)-based periarticular bone area and 3D shape measurements were used. The association between bisphosphonate intake and 24-month interval changes of the periarticular bone area and 3D shape were evaluated using paired Wilcoxon signed rank test. We used conditional logistic regression models for determining the association between bisphosphonate intake and periarticular bone change, defined using the standard deviation of difference (SDD) and reliable change index (RCI) methods. P-values have been adjusted for multiple comparisons using Benjamini & Hochberg procedure and false discovery rate (FDR)-adjusted P-values were reported. RESULTS: The 24-month interval increases in the periarticular bone area in medial side of tibia were significantly greater in non-users than users (FDR-adjusted P-value: 0.002). There was an approaching significance trend for lower medial tibial periarticular bone area expansion in bisphosphonate users in comparison with non-users (For 1SDD change, odds ratio 95% confidence interval (OR (95% CI)): 0.514 (0.271-0.975), FDR-adjusted P-value: 0.085) (For 1.96RCI change, OR (95% CI): 0.552 (0.309-0.986), FDR-adjusted P-value: 0.085). CONCLUSIONS: Bisphosphonate intake was associated with a reduction in the odds (approaching but not achieving significance) of expansion periarticular bone area, specifically in the medial tibial sub-region.
EVALuna2:36259

Blockade of TNF-α rapidly inhibits pain responses in the central nervous system - Heß, Andreas; Axmann, Roland; Rech, Jürgen; Finzel, Stephanie; Heindl-Erdmann, Cornelia; Kreitz, Silke; Sergeeva, Marina; Saake, Marc; Garcia, Meritxell; Kollias, George; Straub, Rainer H.; Sporns, Olaf; et al. (Proceedings of the National Academy of Sciences of the United States of America, 2011)
There has been a consistent gap in understanding how TNF-α neutralization affects the disease state of arthritis patients so rapidly, considering that joint inflammation in rheumatoid arthritis is a chronic condition with structural changes. We thus hypothesized that neutralization of TNF-α acts through the CNS before directly affecting joint inflammation. Through use of functional MRI (fMRI), we demonstrate that within 24 h after neutralization of TNF-α, nociceptive CNS activity in the thalamus and somatosensoric cortex, but also the activation of the limbic system, is blocked. Brain areas showing blood-oxygen level-dependent signals, a validated method to assess neuronal activity elicited by pain, were significantly reduced as early as 24 h after an infusion of a monoclonal antibody to TNF-α. In contrast, clinical and laboratory markers of inflammation, such as joint swelling and acute phase reactants, were not affected by anti-TNF-α at these early time points. Moreover, arthritic mice overexpressing human TNF-α showed an altered pain behavior and amore intensive, widespread, and prolonged brain activity upon nociceptive stimuli compared with wild-type mice. Similar to humans, these changes, as well as the rewiring of CNS activity resulting in tight clustering in the thalamus, were rapidly reversed after neutralization of TNF-α. These results suggest that neutralization of TNF-α affects nociceptive brain activity in the context of arthritis, long before it achieves antiinflammatory effects in the joints.
CRIS-Team Scopus Importer:2021-02-03
Keywords: Antiinflammatory therapy; Cytokines

Blood Pressure and Anticoagulation Reversal Management during Off-Hours in Oral Anticoagulation-Associated Intracerebral Hemorrhage - Mrochen, Anne; Sprügel, Maximilian; Gerner, Stefan; Sembill, Jochen; Lang, Stefan; Lücking, Hannes; Kuramatsu, Joji; Huttner, Hagen (Cerebrovascular Diseases, 2020)
Background: Prevention of hematoma enlargement in oral anticoagulation-associated intracerebral hemorrhage (OAC-ICH) focuses on blood pressure (BP) reduction and OAC reversal. We investigated whether treatment efficiency and clinical outcomes differ between OAC-ICH patients admitted outside versus during regular working hours. Methods: Based on pooled data of multicenter cohort studies, we grouped OAC-ICH patients (vitamin K antagonist [VKA], non-vitamin K oral anticoagulant [NOAC]) according to on-vs. off-hour admission. Primary outcome was the functional outcome using the modified Rankin scale (mRS) dichotomized into favorable (mRS 0-3) and unfavorable (mRS 4-6) and mortality at 3 months. Secondary outcome measures included the occurrence of hematoma enlargement, the proportions of patients with systolic BP <140 mm Hg and with anticoagulation treatment achieving international normalized ratio (INR) levels <1.3 at 4 h. Propensity score matching (PSM) was performed to account for imbalances in baseline characteristics. Results: The study population consisted of 76/126 NOAC-ICH patients and 1,005/1,470 VKA patients presenting during off-hours. Functional outcome and mortality rates were not significantly different among PSM patients with VKA-ICH and NOAC-ICH during on-vs. off-hours (mRS 4-6 VKA-ICH: On-hour: 239/357 [66.9%] vs. 253/363 [69.7%] off-hour; p = 0.43; NOAC-ICH: On-hour 26/42 [61.9%] vs. off-hour: 37/57 [64.9%]; p = 0.76; mRS 6 VKA-ICH: On-hour: 127/357 [35.6%] vs. off-hour: 148/363 [40.8%]; p = 0.15;-NOAC-ICH: On-hour 17/42 [40.5%] vs. off-hour: 16/57 [28.1%]; p = 0.20). There were no differences detectable regarding the secondary outcome measures (i.e., hematoma enlargement, the proportion of patients who achieved systolic BP levels <140 mm Hg at 4 h as well as anticoagulation treatment achieving INR levels <1.3 at 4 h) in OAC patients. Conclusion: Our study implies that BP reduction and anticoagulation reversal management are well established and associated with similar rates of hematoma enlargement and clinical outcomes in on-vs. off-hour admitted OAC-ICH patients.
CRIS-Team Scopus Importer:2020-05-12
Keywords: Clinical outcome; Intracerebral hemorrhage; Non-vitamin K oral anticoagulant; Off-hour; Oral anticoagulation; Vitamin K antagonist

Blood pressure lowering with alcohol-mediated renal denervation using the Peregrine infusion Catheter is independent of injection site location - Mahfoud, Felix; Bertog, Stefan; Lauder, Lucas; Bohm, Michael; Schmid, Axel; Wojakowski, Wojciech; Parise, Helen; Fischell, Tim A.; Kandzari, David E.; Pathak, Atul; Persu, Alexandre; Sievert, Horst (Catheterization and Cardiovascular Interventions, 2021)
Objectives: The current analysis utilized core laboratory angiographic data from a prospective, single-arm, open-label, multi-center feasibility study to ascertain whether the location of alcohol infusion within main renal arteries during renal denervation (RDN) had an impact on the BP-lowering effect at 6 months. Background: The influence of the location of alcohol infusion during RDN, within the main renal artery (proximal, middle, or distal), on the magnitude of the blood pressure (BP) lowering is unstudied. Methods: The Peregrine Catheter was used to perform alcohol-mediated RDN with an infusion of 0.6 mL of alcohol per artery as the neurolytic agent in 90 main arteries and four accessory arteries of 45 patients with hypertension. Results: No relationship between the site of alcohol infusion and change from baseline in both office systolic and 24-hour systolic ambulatory BP (ABP) at 6 months was observed. When analyzed at the artery level, the least squares (LS) mean changes ± SEM from baseline to 6 months post-procedure in 24-hour systolic ABP when analyzed by renal arterial location were −11.9 ± 2.4 mmHg (distal), −10 ± 1.6 mmHg (middle), and −10.6 ± 1.3 mmHg (proximal) (all p < 0.0001 for change from baseline within groups). The results were similar for office systolic BP. There was no difference between treated locations (proximal is reference). Conclusion: In this post-hoc analysis, the location of alcohol infusion within the main renal artery using the Peregrine system, with alcohol as the neurolytic agent for chemical RDN, did not affect the magnitude of BP changes at 6 months.
CRIS-Team Scopus Importer:2021-09-17
Keywords: angiography; hypertension; renal artery

Blood Pressure Pattern and Target Organ Damage in Patients With Chronic Kidney Disease - Scheppach, Johannes B.; Raff, Ulrike; Toncar, Sebastian; Ritter, Christian; Klink, Thorsten; Stoerk, Stefan; Wanner, Christoph; Schlieper, Georg; Saritas, Turgay; Reinartz, Sebastian D.; Floege, Juergen; Janka, Rolf Matthias; et al. (Hypertension, 2018)
In patients with chronic kidney disease, data on blood pressure (BP) pattern and its association with target organ damage, which indicates elevated cardiovascular risk, are sparse. In 305 treated hypertensive chronic kidney disease patients, we assessed BP pattern, left ventricular mass (magnetic resonance imaging), intima-media thickness (ultrasound), 24-hour-pulse wave velocity and 24-hour-central augmentation index (Mobil-O-Graph). Controlled hypertension (normal office and ambulatory BP) was found in 41% and sustained uncontrolled hypertension (elevated office and ambulatory BP) in 30% of patients. Misclassification of BP status occurred in 29%: white coat uncontrolled hypertension (elevated office but normal ambulatory BP) was detected in 11% and masked uncontrolled hypertension (normal office but elevated ambulatory BP) in 18% of patients. Left ventricular mass was increased in white coat uncontrolled hypertension (+11.2 g), masked uncontrolled hypertension (+9.4 g), and sustained uncontrolled hypertension (+16.6 g) compared with controlled hypertension. Intima-media thickness was similar across all 4 BP groups. Twenty-four hour-pulse wave velocity and 24-hour-central augmentation index were increased in masked uncontrolled hypertension (+0.5 m/sec and +2.5%) and sustained uncontrolled hypertension (+0.5 m/sec and +2.9%) compared with controlled hypertension. In conclusion, based on office BP measurements, misclassification of true BP status occurred in almost one-third of chronic kidney disease patients. Both types of misclassification (white coat uncontrolled hypertension and masked uncontrolled hypertension) were associated with parameters of target organ damage. Ambulatory BP monitoring should be used routinely to identify chronic kidney disease patients at high cardiovascular risk.
EVALuna2:34688

Blood pressure reduction after renal denervation in patients with or without chronic kidney disease - Günes-Altan, Merve; Schmid, Axel; Ott, Christian; Bosch, Agnes; Pietschner, Robert; Schiffer, Mario; Uder, Michael; Schmieder, Roland; Kannenkeril, Dennis (Clinical Kidney Journal, 2024)
Background. Renal denervation (RDN) has emerged as an adjacent option for the treatment of hypertension. This analysis of the Erlanger registry aimed to compare the blood pressure (BP)-lowering effects and safety of RDN in patients with and without chronic kidney disease (CKD). Methods. In this single-center retrospective analysis, 47 patients with and 127 without CKD underwent radiofrequency-, ultrasound- or alcohol-infusion-based RDN. Office and 24-h ambulatory BP and estimated glomerular filtration rate (eGFR) were measured at baseline, and after 6 and 12 months. Results. A total of 174 patients with a mean age of 59.0 ± 10 years were followed up for 12 months. At baseline, mean eGFR was 55.8 ± 21 mL/min/1.73 m2 in patients with CKD and 87.3 ± 13 mL/min/1.73 m2 in patients without CKD. There was no significant eGFR decline in either of the groups during 12 months of follow-up. In patients without CKD, office systolic and diastolic BP were reduced by –15.3 ± 17.5/–7.9 ± 10.8 mmHg 6 months after RDN and by –16.1 ± 18.2/–7.7 ± 9.6 mmHg 12 months after RDN. In patients with CKD, office systolic and diastolic BP were reduced by –10.7 ± 24.0/–5.8 ± 13.2 mmHg 6 months after RDN and by –15.1 ± 24.9/–5.9 ± 12.9 mmHg 12 months after RDN. Accordingly, in patients without CKD, 24-h ambulatory systolic and diastolic BP were reduced by –7.2 ± 15.8/–4.9 ± 8.8 mmHg 6 months after RDN and by –9.0 ± 17.0/–6.2 ± 9.8 mmHg 12 months after RDN. In patients with CKD, 24-h systolic and diastolic BP were reduced by –7.4 ± 12.9/–4.2 ± 9.9 mmHg 6 months after RDN and by –8.0 ± 14.0/–3.6 ± 9.6 mmHg 12 months after RDN. There was no difference in the reduction of office and 24-h ambulatory BP between the two groups at any time point (all P > .2). Similar results have been found for the 6 months data. With exception of rare local adverse events, we did not observe any safety signals. Conclusion. According to our single-center experience, we observed a similar reduction in 24-h, day and night-time ambulatory BP as well as in-office BP in patients with and without CKD at any time point up to 12 months. We conclude that RDN is an effective and safe treatment option for patients with hypertension and CKD.
CRIS-Team Scopus Importer:2024-01-26
Keywords: blood pressure; chronic kidney disease; hypertension; post-hoc analysis; renal denervation

BLOOD PRESSURE REDUCTION AFTER RENAL DENERVATION IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE: THE ERLANGER EXPERIENCE - Schmid, Axel; Ott, Christian; Bosch, Agnes; Schiffer, Mario; Uder, Michael; Schmieder, Roland; Kannenkeril, Dennis (JOURNAL OF HYPERTENSION, 2023)
CRIS-Team WoS Importer:2023-03-17

BMD ACCURACY ERRORS IN PHANTOMLESS CALIBRATION OF CT SCANS: A SIMULATION STUDY - Bartenschlager, Stefan; Chaudry, Oliver; Dankerl, Peter; Uder, Michael; Engelke, Klaus (OSTEOPOROSIS INTERNATIONAL, 2021)
Opportunistic screening using existing CT images may be a new strategy to identify subjects at increased risk for osteoporotic fracture. Low bone mineral density (BMD) is a key parameter but routine clinical CT scans do not include a calibration phantom to calculate BMD from the measured CT values. An alternative is internal or phantomless calibration, which is based on the CT values of air and of internal tissues of the subject such as blood, muscle or adipose tissue. However, the composition and as a consequence the CT values of these so-called internal calibration materials vary among subjects, which introduces additional BMD accuracy errors compared to phantom based calibration. The objective of this study was to quantify these accuracy errors and to identify optimum combinations of internal calibration materials (IM) for BMD assessments in opportunistic screening. Based on the base material decomposition theory we demonstrate how BMD can be derived from the CT values of the internal calibration materials. 121 CT datasets of the lumbar spine form postmenopausal women were used to determine the population variance of blood assessed in the aorta or the inferior vena cava, skeletal muscle of the erector spinae or psoas, subcutaneous adipose tissue (SAT) and air. The corresponding standard deviations were used for error propagation to determine phantomless calibration related BMD accuracy errors. Using a CT value of 150 HU, a typical value of trabecular bone, simulated BMD accuracy errors for most IM combinations containing air as one of the two base materials were below 5% or 6 mg/cm3. The lowest errors were determined for the combination of blood and air (<2 mg/cm3). The combination of blood and skeletal muscle resulted in higher errors (>10.5% or >12 mg/cm3) and is not recommended. Due to possible age-related differences in tissue composition, the selection of IMs is suggested to be adapted according to the measured subject. In younger subjects without significant aortic calcifications, air and blood of the aorta may be the best combination whereas in elderly subjects, air and SAT (error of 4%) may be preferable. The use of skeletal muscle as one of the two IMs is discouraged, in particular in elderly subjects because of varying fatty infiltration. A practical implementation of the internal calibration with different IM pairs confirmed the theoretical results. In summary, compared to a phantom based calibration the phantomless approach used for opportunistic screening creates additional BMD accuracy errors of 2% or more, dependent on the used internal reference tissues. The impact on fracture prediction still must be evaluate
CRIS-Team WoS Importer:2022-03-04
Keywords: Opportunistic screening; BMD; Phantomless calibration; QCT; Accuracy errors; Base material decomposition

BMD accuracy errors specific to phantomless calibration of CT scans of the lumbar spine - Bartenschlager, Stefan; Dankerl, Peter; Chaudry, Oliver; Uder, Michael; Engelke, Klaus (Bone, 2022)
Opportunistic screening using existing CT images may be a new strategy to identify subjects at increased risk for osteoporotic fracture. Low bone mineral density (BMD) is a key parameter but routine clinical CT scans do not include a calibration phantom to calculate BMD from the measured CT values. An alternative is internal or phantomless calibration, which is based on the CT values of air and of internal tissues of the subject such as blood, muscle or adipose tissue. However, the composition and as a consequence the CT values of these so-called internal calibration materials vary among subjects, which introduces additional BMD accuracy errors compared to phantom based calibration. The objective of this study was to quantify these accuracy errors and to identify optimum combinations of internal calibration materials (IM) for BMD assessments in opportunistic screening. Based on the base material decomposition theory we demonstrate how BMD can be derived from the CT values of the internal calibration materials. 121 CT datasets of the lumbar spine form postmenopausal women were used to determine the population variance of blood assessed in the aorta or the inferior vena cava, skeletal muscle of the erector spinae or psoas, subcutaneous adipose tissue (SAT) and air. The corresponding standard deviations were used for error propagation to determine phantomless calibration related BMD accuracy errors. Using a CT value of 150 HU, a typical value of trabecular bone, simulated BMD accuracy errors for most IM combinations containing air as one of the two base materials were below 5% or 6 mg/cm3. The lowest errors were determined for the combination of blood and air (<2 mg/cm3). The combination of blood and skeletal muscle resulted in higher errors (>10.5% or >12 mg/cm3) and is not recommended. Due to possible age-related differences in tissue composition, the selection of IMs is suggested to be adapted according to the measured subject. In younger subjects without significant aortic calcifications, air and blood of the aorta may be the best combination whereas in elderly subjects, air and SAT (error of 4%) may be preferable. The use of skeletal muscle as one of the two IMs is discouraged, in particular in elderly subjects because of varying fatty infiltration. A practical implementation of the internal calibration with different IM pairs confirmed the theoretical results. In summary, compared to a phantom based calibration the phantomless approach used for opportunistic screening creates additional BMD accuracy errors of 2% or more, dependent on the used internal reference tissues. The impact on fracture prediction still must be evaluated.
CRIS-Team Scopus Importer:2022-01-28
Keywords: Accuracy errors; Base material decomposition; BMD; Opportunistic screening; Phantomless calibration; QCT

Bone Metastases Are Measurable: The Role of Whole-Body MRI and Positron Emission Tomography - Oprea-Lager, Daniela E.; Cysouw, Matthijs C.F.; Boellaard, Ronald; Deroose, Christophe M.; de Geus-Oei, Lioe Fee; Lopci, Egesta; Bidaut, Luc; Herrmann, Ken; Fournier, Laure S.; Bäuerle, Tobias; deSouza, Nandita M.; Lecouvet, Frederic E. (Frontiers in Oncology, 2021)
Metastatic tumor deposits in bone marrow elicit differential bone responses that vary with the type of malignancy. This results in either sclerotic, lytic, or mixed bone lesions, which can change in morphology due to treatment effects and/or secondary bone remodeling. Hence, morphological imaging is regarded unsuitable for response assessment of bone metastases and in the current Response Evaluation Criteria In Solid Tumors 1.1 (RECIST1.1) guideline bone metastases are deemed unmeasurable. Nevertheless, the advent of functional and molecular imaging modalities such as whole-body magnetic resonance imaging (WB-MRI) and positron emission tomography (PET) has improved the ability for follow-up of bone metastases, regardless of their morphology. Both these modalities not only have improved sensitivity for visual detection of bone lesions, but also allow for objective measurements of bone lesion characteristics. WB-MRI provides a global assessment of skeletal metastases and for a one-step “all-organ” approach of metastatic disease. Novel MRI techniques include diffusion-weighted imaging (DWI) targeting highly cellular lesions, dynamic contrast-enhanced MRI (DCE-MRI) for quantitative assessment of bone lesion vascularization, and multiparametric MRI (mpMRI) combining anatomical and functional sequences. Recommendations for a homogenization of MRI image acquisitions and generalizable response criteria have been developed. For PET, many metabolic and molecular radiotracers are available, some targeting tumor characteristics not confined to cancer type (e.g. 18F-FDG) while other targeted radiotracers target specific molecular characteristics, such as prostate specific membrane antigen (PSMA) ligands for prostate cancer. Supporting data on quantitative PET analysis regarding repeatability, reproducibility, and harmonization of PET/CT system performance is available. Bone metastases detected on PET and MRI can be quantitatively assessed using validated methodologies, both on a whole-body and individual lesion basis. Both have the advantage of covering not only bone lesions but visceral and nodal lesions as well. Hybrid imaging, combining PET with MRI, may provide complementary parameters on the morphologic, functional, metabolic and molecular level of bone metastases in one examination. For clinical implementation of measuring bone metastases in response assessment using WB-MRI and PET, current RECIST1.1 guidelines need to be adapted. This review summarizes available data and insights into imaging of bone metastases using MRI and PET.
CRIS-Team Scopus Importer:2021-12-17
Keywords: bone metastases; measurable; MRI; PET; response

Bone Structure Analysis of the Radius Using Ultrahigh Field (7T) MRI: Relevance of Technical Parameters and Comparison with 3T MRI and Radiography - Jarraya, Mohamed; Heiß, Rafael; Duryea, Jeffrey; Nagel, Armin Michael; Lynch, John A.; Guermazi, Ali; Weber, Marc-Andre; Arkudas, Andreas; Horch, Raymund E.; Uder, Michael; Roemer, Frank (Diagnostics, 2021)
Bone fractal signature analysis (FSA-also termed bone texture analysis) is a tool that assesses structural changes that may relate to clinical outcomes and functions. Our aim was to compare bone texture analysis of the distal radius in patients and volunteers using radiography and 3T and 7T magnetic resonance imaging (MRI)-a patient group (n = 25) and a volunteer group (n = 25) were included. Participants in the patient group had a history of chronic wrist pain with suspected or confirmed osteoarthritis and/or ligament instability. All participants had 3T and 7T MRI including T1-weighted turbo spin echo (TSE) sequences. The 7T MRI examination included an additional high-resolution (HR) T1 TSE sequence. Radiographs of the wrist were acquired for the patient group. When comparing patients and volunteers (unadjusted for gender and age), we found a statistically significant difference of horizontal and vertical fractal dimensions (FDs) using 7T T1 TSE-HR images in low-resolution mode (horizontal: p = 0.04, vertical: p = 0.01). When comparing radiography to the different MRI sequences, we found a statistically significant difference for low- and high-resolution horizontal FDs between radiography and 3T T1 TSE and 7T T1 TSE-HR. Vertical FDs were significantly different only between radiographs and 3T T1 TSE in the high-resolution mode; FSA measures obtained from 3T and 7T MRI are highly dependent on the sequence and reconstruction resolution used, and thus are not easily comparable between MRI systems and applied sequences.
CRIS-Team WoS Importer:2021-02-12

Brain correlates of short-term habituation to repetitive electrical noxious stimulation - Nickel, Franziska; Ott, Sabine; Möhringer, Susanne; Saake, Marc; Dörfler, Arnd; Seifert, Frank; Maihöfner, Christian (European Journal of Pain, 2014)
Habituation to repetitive noxious stimuli is a well-known phenomenon. We investigated brain correlates of habituation to pain in a transdermal electrical pain model using functional magnetic resonance imaging (fMRI).Electrical painful stimulation with 1 Hz was applied to the volar forearm of 48 healthy subjects for 45 min. Before and after conditioning stimulation, psychophysical testing and fMRI were performed. During fMRI sessions, the subjects underwent blockwise painful electrical stimulation with a fixed percept-adapted current intensity. After fMRI 1 and fMRI 2 subjects rated the individual pain intensity of the electrical stimulus.Substantial habituation occurred during conditioning electrical stimulation. Accordingly, areas typically involved in pain processing showed decreased activity after conditioning stimulation. The blood oxygen level-dependent signal of the subgenual anterior cingulate gyrus, the superior parietal lobule and the supplemental motor area correlated positively with habituation. In contrast, activity in the periaqueductal grey, thalamus and insula correlated negatively. The results of the correlation analyses did not survive correction for multiple comparisons.With this study, we identified central components associated with habituation to repetitive painful stimuli. The results suggest that an increase in tonic inhibitory activity in cortical pain processing areas is a major mechanism contributing to habituation to phasic noxious stimuli. Moreover, areas involved in descending pain modulation were differentially modulated. This may hint at a simultaneous activation of facilitating and inhibiting nociceptive systems that are both altered in the transdermal electrical pain model.
EVALuna2:14468

Brain fMRI Predicts Responses to Certolizumab Pegol in RA. an International, Multi-center, Randomized, Double-blind, Placebocontrolled Trial (PreCePRA) - Rech, Jürgen; Schenker, Hannah; Tascilar, Koray; Hagen, Melanie; Kleyer, Arnd; Simon, David; Mendez, Larissa Valor; Schoenau, Verena; Prade, Jutta; Sergeeva, Marina; Sulvakumar, Mageshvar; Strobelt, Sandra; et al. (ARTHRITIS & RHEUMATOLOGY, 2020)
CRIS-Team WoS Importer:2021-01-15

Brain Mechanisms of Abnormal Temperature Perception in Cold Allodynia induced by Ciguatoxin - Eisenblätter, Anneka; Lewis, Richard; Dörfler, Arnd; Forster, Clemens; Zimmermann, Katharina (Annals of Neurology, 2016)
Cold allodynia occurs as a major symptom of neuropathic pain states. It remains poorly treated with current analgesics. Ciguatoxins (CTXs), ichthyosarcotoxins that cause ciguatera, produce a large peripheral sensitization to dynamic cold stimuli in A?-fibers by activating sodium channels without producing heat or mechanical allodynia. We used CTXs as surrogate model of cold allodynia to dissect the framework of cold allodynia activated central pain pathways.Reversible cold allodynia was induced in healthy male volunteers by shallow intracutaneous injection of low nM concentrations of CTX into the dorsal skin of the forefoot. Cold and warm stimuli were delivered to the treated and the control site using a peltier driven thermotest device. Functional Magnetic Resonance Imaging (fMRI) scans were acquired with a 3 Tesla MRI scanner using a blood-oxygen-level-dependent (BOLD) protocol.The CTX-induced substantial peripheral sensitization to cooling stimuli in A?-fibers is particularly retrieved in BOLD changes due to dynamic temperature changes and less during constant cooling. Brain areas which responded during cold allodynia were always located bilateral and appeared in the medial insula, the medial cingulate cortex, the secondary somatosensory cortex, in frontal areas and the cerebellum. While these areas produced also changes in BOLD-signal during the dynamic warming stimulus on the control site they remained silent during the warming stimuli on the injected site.We describe the defining feature of the cold allodynia pain percept in the human brain and illustrate why ciguatera sufferers often report a perceptual temperature reversal. This article is protected by copyright. All rights reserved.
EVALuna2:16742

Brain MRI Lesions are Related to Bowel Incontinence in Multiple Sclerosis - Fröhlich, Katharina; Linker, Ralf; Engelhorn, Tobias; Dörfler, Arnd; Lee, De-Hyung; Huhn, Konstantin; Schwab, Stefan; Hilz, Max-Josef; Seifert, Frank; Winder, Klemens (Journal of Neuroimaging, 2018)
BACKGROUND AND PURPOSE: Bowel incontinence in multiple sclerosis might be associated with specific lesion sites. This study intended to determine associations between bowel incontinence and cerebral multiple sclerosis lesions using a voxel-wise lesion symptom mapping analysis. METHODS: We conducted a retrospective study of multiple sclerosis patients with self-reported bowel incontinence and matched controls. Lesions were manually outlined on T2-weighted MRI scans and transformed into stereotaxic space. We performed a voxel-wise subtraction analysis subtracting the lesion overlap of patients without from patients with bowel incontinence. Finally, we compared the absence or presence of bowel incontinence between patients with and without lesions in a given voxel using the Liebermeister test. RESULTS: A total of 51 patients were included in the study. The analysis yielded associations between bowel incontinence and lesions in the supramarginal gyrus of the left secondary somatosensory cortex and another lesion cluster in the right parahippocampal gyrus and amygdala. CONCLUSIONS: Our analysis indicates associations between bowel incontinence and lesions in the left supramarginal gyral area contributing to integrating anorectal-visceral sensation and in the right parahippocampal gyrus and amygdala contributing to generating visceral autonomic arousal states. Moreover, our results suggest left hemispheric dominance of sensory visceral integration, while limbic areas of the right hemisphere seem to contribute to the autonomic component of the defecation process. A limitation of our study is the retrospective evaluation of the bowel incontinence status based on medical records. Further research should evaluate the bowel incontinence status in multiple sclerosis patients prospectively to overcome the limitations of the current study.
EVALuna2:36318

Brain Structure in Acutely Underweight and Partially Weight-Restored Individuals With Anorexia Nervosa: A Coordinated Analysis by the ENIGMA Eating Disorders Working Group - Walton, Esther; Bernardoni, Fabio; Batury, Victoria Luise; Bahnsen, Klaas; Larivière, Sara; Abbate-Daga, Giovanni; Andres-Perpiña, Susana; Bang, Lasse; Bischoff-Grethe, Amanda; Brooks, Samantha J.; Campbell, Iain C.; Cascino, Giammarco; et al. (Biological Psychiatry, 2022)
Background: The pattern of structural brain abnormalities in anorexia nervosa (AN) is still not well understood. While several studies report substantial deficits in gray matter volume and cortical thickness in acutely underweight patients, others find no differences, or even increases in patients compared with healthy control subjects. Recent weight regain before scanning may explain some of this heterogeneity. To clarify the extent, magnitude, and dependencies of gray matter changes in AN, we conducted a prospective, coordinated meta-analysis of multicenter neuroimaging data. Methods: We analyzed T1-weighted structural magnetic resonance imaging scans assessed with standardized methods from 685 female patients with AN and 963 female healthy control subjects across 22 sites worldwide. In addition to a case-control comparison, we conducted a 3-group analysis comparing healthy control subjects with acutely underweight AN patients (n = 466) and partially weight-restored patients in treatment (n = 251). Results: In AN, reductions in cortical thickness, subcortical volumes, and, to a lesser extent, cortical surface area were sizable (Cohen's d up to 0.95), widespread, and colocalized with hub regions. Highlighting the effects of undernutrition, these deficits were associated with lower body mass index in the AN sample and were less pronounced in partially weight-restored patients. Conclusions: The effect sizes observed for cortical thickness deficits in acute AN are the largest of any psychiatric disorder investigated in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium to date. These results confirm the importance of considering weight loss and renutrition in biomedical research on AN and underscore the importance of treatment engagement to prevent potentially long-lasting structural brain changes in this population.
CRIS-Team Scopus Importer:2022-09-09
Keywords: BMI; Cortical thickness; MRI; Subcortical volume; Surface area

Brain tissues have single-voxel signatures in multi-spectral MRI - German, Alexander; Mennecke, Angelika; Martin, Jan; Hanspach, Jannis; Liebert, Andrzej; Herrler, Jürgen; Kuder, Tristan Anselm; Schmidt, Manuel; Nagel, Armin Michael; Uder, Michael; Dörfler, Arnd; Winkler, Jürgen; et al. (NeuroImage, 2021)
Since the seminal works by Brodmann and contemporaries, it is well-known that different brain regions exhibit unique cytoarchitectonic and myeloarchitectonic features. Transferring the approach of classifying brain tissues – and other tissues – based on their intrinsic features to the realm of magnetic resonance (MR) is a longstanding endeavor. In the 1990s, atlas-based segmentation replaced earlier multi-spectral classification approaches because of the large overlap between the class distributions. Here, we explored the feasibility of performing global brain classification based on intrinsic MR features, and used several technological advances: ultra-high field MRI, q-space trajectory diffusion imaging revealing voxel-intrinsic diffusion properties, chemical exchange saturation transfer and semi-solid magnetization transfer imaging as a marker of myelination and neurochemistry, and current neural network architectures to analyze the data. In particular, we used the raw image data as well to increase the number of input features. We found that a global brain classification of roughly 97 brain regions was feasible with gross classification accuracy of 60%; and that mapping from voxel-intrinsic MR data to the brain region to which the data belongs is possible. This indicates the presence of unique MR signals of different brain regions, similar to their cytoarchitectonic and myeloarchitectonic fingerprints.
CRIS-Team Scopus Importer:2021-04-16
Keywords: Brain; Data Analysis; High-Field Imaging; Machine Learning; MRI; Segmentation

Brain volume reduction after whole-brain radiotherapy: quantification and prognostic relevance - Hoffmann, Christian; Distel, Luitpold; Knippen, Stefan; Gryc, Thomas; Schmidt, Manuel; Fietkau, Rainer; Putz, Florian (Neuro-Oncology, 2018)
Background: Recent studies have questioned the value of adding whole-brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) for brain metastasis treatment. Neurotoxicity, including radiation-induced brain volume reduction, could be one reason why not all patients benefit from the addition of WBRT. In this study, we quantified brain volume reduction after WBRT and assessed its prognostic significance. Methods: Brain volumes of 91 patients with cerebral metastases were measured during a 150-day period after commencing WBRT and were compared with their pretreatment volumes. The average daily relative change in brain volume of each patient, referred to as the "brain volume reduction rate," was calculated. Univariate and multivariate Cox regression analyses were performed to assess the prognostic significance of the brain volume reduction rate, as well as of 3 treatment-related and 9 pretreatment factors. A one-way analysis of variance was used to compare the brain volume reduction rate across recursive partitioning analysis (RPA) classes. Results: On multivariate Cox regression analysis, the brain volume reduction rate was a significant predictor of overall survival after WBRT (P < 0.001), as well as the number of brain metastases (P = 0.002) and age (P = 0.008). Patients with a relatively favorable prognosis (RPA classes 1 and 2) experienced significantly less brain volume decrease after WBRT than patients with a poor prognosis (RPA class 3) (P = 0.001). There was no significant correlation between delivered radiation dose and brain volume reduction rate (P = 0.147). Conclusion: In this retrospective study, a smaller decrease in brain volume after WBRT was an independent predictor of longer overall survival.
EVALuna2:36468

Breast cancer imaging with glucosamine CEST (chemical exchange saturation transfer) MRI: first human experience - Rivlin, Michal; Anaby, Debbie; Nissan, Noam; Zaiß, Moritz; Deshmane, Anagha; Navon, Gil; Sklair-Levy, Miri (European Radiology, 2022)
Objectives: This study aims to evaluate the feasibility of imaging breast cancer with glucosamine (GlcN) chemical exchange saturation transfer (CEST) MRI technique to distinguish between tumor and surrounding tissue, compared to the conventional MRI method. Methods: Twelve patients with newly diagnosed breast tumors (median age, 53 years) were recruited in this prospective IRB-approved study, between August 2019 and March 2020. Informed consent was obtained from all patients. All MRI measurements were performed on a 3-T clinical MRI scanner. For CEST imaging, a fat-suppressed 3D RF-spoiled gradient echo sequence with saturation pulse train was applied. CEST signals were quantified in the tumor and in the surrounding tissue based on magnetization transfer ratio asymmetry (MTRasym) and a multi-Gaussian fitting. Results: GlcN CEST MRI revealed higher signal intensities in the tumor tissue compared to the surrounding breast tissue (MTRasym effect of 8.12 ± 4.09%, N = 12, p = 2.2 E−03) with the incremental increase due to GlcN uptake of 3.41 ± 0.79% (N = 12, p = 2.2 E−03), which is in line with tumor location as demonstrated by T1W and T2W MRI. GlcN CEST spectra comprise distinct peaks corresponding to proton exchange between free water and hydroxyl and amide/amine groups, and relayed nuclear Overhauser enhancement (NOE) from aliphatic groups, all yielded larger CEST integrals in the tumor tissue after GlcN uptake by an averaged factor of 2.2 ± 1.2 (p = 3.38 E−03), 1.4 ± 0.4 (p =9.88 E−03), and 1.6 ± 0.6 (p = 2.09 E−02), respectively. Conclusion: The results of this initial feasibility study indicate the potential of GlcN CEST MRI to diagnose breast cancer in a clinical setup. Key Points: • GlcN CEST MRI method is demonstrated for its the ability to differentiate between breast tumor lesions and the surrounding tissue, based on the differential accumulation of the GlcN in the tumors. • GlcN CEST imaging may be used to identify metabolic active malignant breast tumors without using a Gd contrast agent. • The GlcN CEST MRI method may be considered for use in a clinical setup for breast cancer detection and should be tested as a complementary method to conventional clinical MRI methods.
CRIS-Team Scopus Importer:2022-04-22
Keywords: Breast neoplasms; Contrast media; Diagnostic imaging; Glucosamine; Magnetic resonance imaging

Breast cancer risk - Genes, environment and clinics Mammakarzinomrisiko - Gene, Umwelt und Klinik - Fasching, Peter; Ekici, Arif Bülent; Adamietz, B. R.; Wachter, David Lukas; Hein, Alexander; Bayer, Christian M.; Häberle, Lothar; Löhberg, Christian; Jud, Sebastian; Heusinger, K.; Rübner, Matthias; Rauh, Claudia; et al. (Geburtshilfe und Frauenheilkunde, 2011)
The information available about breast cancer risk factors has increased dramatically during the last 10 years. In particular, studies of low-penetrance genes and mammographic density have improved our understanding of breast cancer risk. In addition, initial steps have been taken in investigating interactions between genes and environmental factors. This review concerns with actual data on this topic. Several genome-wide association studies (GWASs) with a casecontrol design, as well as large-scale validation studies, have identified and validated more than a dozen single nucleotide polymorphisms (SNPs) associated with breast cancer risk. They are located not only in or close to genes known to be involved in cancer pathogenesis, but also in genes not previously associated with breast cancer pathogenesis, or may even not be related to any genes. SNPs have also been identified that alter the lifetime risk in BRCA mutation carriers. With regard to nongenetic risk factors, studies of postmenopausal hormone replacement therapy (HRT) have revealed important information on how to weigh up the risks and benefits of HRT. Mammographic density (MD) has become an accepted and important breast cancer risk factor. Lifestyle and nutritional considerations have become an integral part of most studies of breast cancer risk, and some improvements have been made in this field as well. More than 10 years after the publication of the first breast cancer prevention studies with tamoxifen, other substances such as raloxifene and aromatase inhibitors have been investigated and have also been shown to have preventive potential. Finally, mammographic screening systems have been implemented in most Western countries during the last decade. These may be developed further by including more individualized methods of predicting the patients breast cancer risk. © Georg Thieme Verlag KG Stuttgart - New York.
CRIS-Team Scopus Importer:2021-07-19
Keywords: BRCA (breast cancer antigen); breast; breast feeding; CAM (Complementary and Alternative medicine); cancer registry; estrogen receptor

Breast MRI at Very Short TE (minTE): Image Analysis of minTE Sequences on Non-Fat-Saturated, Subtracted T1-Weighted Images - Wenkel, Evelyn; Janka, Rolf Matthias; Geppert, Christian; Kämmerer, Nadine; Hartmann, Arndt; Uder, Michael; Hammon, Matthias; Brand, Michael (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2017)
Purpose The aim was to evaluate a minimum echo time (minTE) protocol for breast magnetic resonance imaging (MRI) in patients with breast lesions compared to a standard TE (nTE) time protocol. Methods Breasts of 144 women were examined with a 1.5 Tesla MRI scanner. Additionally to the standard gradient-echo sequence with nTE (4.8 ms), a variant with minimum TE (1.2 ms) was used in an interleaved fashion which leads to a better temporal resolution and should reduce the scan time by approximately 50 %. Lesion sizes were measured and the signal-to-noise ratio (SNR) as well as the contrast-to-noise ratio (CNR) were calculated. Subjective confidence was evaluated using a 3-point scale before looking at the nTE sequences (1 = very sure that I can identify a lesion and classify it, 2 = quite sure that I can identify a lesion and classify it, 3 = definitely want to see nTE for final assessment) and the subjective image quality of all examinations was evaluated using a four-grade scale (1 = sharp, 2 = slight blur, 3 = moderate blur and 4 = severe blur/not evaluable) for lesion and skin sharpness. Lesion morphology and contrast enhancement were also evaluated. Results With minTE sequences, no lesion was rated with "definitely want to see nTE sequences for final assessment". The difference of the longitudinal and transverse diameter did not differ significantly (p > 0.05). With minTE, lesions and skin were rated to be significantly more blurry (p < 0.01 for lesions and p < 0.05 for skin). There was no difference between both sequences with respect to SNR, CNR, lesion morphology, contrast enhancement and detection of multifocal disease. Conclusion Dynamic breast MRI with a minTE protocol is feasible without a major loss of information (SNR, CNR, lesion morphology, contrast enhancement and lesion sizes) and the temporal resolution can be increased by a factor of 2 using minTE sequences. Key points · Increase of temporal resolution for a better in-flow curve.. · Dynamic breast MRI with a shorter TE time is possible without relevant loss of information.. · Possible decrease of the overall scan time.. Citation Format · Wenkel E, Janka R, Geppert C et al. Breast MRI at Very Short TE (minTE): Image Analysis of minTE Sequences on Non-Fat-Saturated, Subtracted T1-Weighted Images. Fortschr Röntgenstr 2017; 189: 137 - 145.
EVALuna2:6843

Breast MRI in the era of diffusion weighted imaging: do we still need signal-intensity time curves? - Dietzel, Matthias; Ellmann, Stephan; Schulz-Wendtland, Rüdiger; Clauser, Paola; Wenkel, Evelyn; Uder, Michael; Baltzer, Pascal A.T. (European Radiology, 2019)
Objective: Dynamic contrast-enhanced imaging of the initial (IP) and delayed phase (DP) is an integral part of any clinical breast MRI protocol. Furthermore, DWI is increasingly used as an add-on sequence by the breast-imaging community. We investigated whether DWI could be used as a substitute DP. Material and methods: One hundred thirty-two consecutive patients with equivocal or suspicious findings at ultrasound and/or mammography received a full diagnostic breast MRI according to international recommendations. Histopathological verification served as reference standard. We evaluated three sections of the MRI protocol: IP, DP, and apparent diffusion coefficient (ADC) maps derived from DWI. Circular ROIs (regions of interest, mean size 5–10 mm2) were drawn into the enhancing parts of the lesion (first postcontrast). ROIs were transferred to the corresponding location on ADC maps and IP and DP images. Mean ROI values were investigated signal intensity (SI): (1) Initial-phase enhancement = (SI(IP) − SI(precontrast))/SI(precontrast); (2) Delayed-phase enhancement = (SI(DP) − SI(IP))/SI(IP); (3) ADC. Multiparametric combinations were computed using logistic regression analysis: (1) IP+: Initial-phase enhancement and ADC; (2) Curve: Initial-phase enhancement and delayed-phase enhancement; (3) Curve+: Curve and ADC. The diagnostic performances of these feature combinations to diagnose malignancy were compared by the area under the receiver-operating characteristics curve (AUC). Results: One hundred thirty-two patients (age: mean = 57.1 years, range 23–83 years) with 145 lesions were included (malignant/benign 101/44). IP+ (AUC = 0.877) outperformed Curve (AUC = 0.788, p = 0.03). Curve+ was not superior to IP+ (p = 1). Conclusion: DWI could substitute DP. Because DWI is typically used as an add-on to IP and DP, our results might help to abbreviate and to simplify current practice of breast MRI. Key Points: • DWI provides similar but superior diagnostic information for diagnosis of malignancy in enhancing breast lesions compared to DP. • Adding DP to DWI does not provide incremental information to distinguish benign from malignant lesions. • DWI could substitute DP. As DWI is typically used as an add-on to IP and DP, our findings might help to abbreviate and to simplify current breast MRI practice.
CRIS-Team Scopus Importer:2019-08-06
Keywords: Breast neoplasms; Diagnostic techniques and procedures; Differential diagnosis; Diffusion magnetic resonance imaging; Magnetic resonance imaging

Breast MRI in the era of diffusion weighted imaging: do we still need signal-intensity time curves? - Dietzel, Matthias; Ellmann, Stephan; Schulz-Wendtland, Rüdiger; Clauser, Paola; Wenkel, Evelyn; Uder, Michael; Baltzer, Pascal A. T. (European Radiology, 2020)
OBJECTIVE: Dynamic contrast-enhanced imaging of the initial (IP) and delayed phase (DP) is an integral part of any clinical breast MRI protocol. Furthermore, DWI is increasingly used as an add-on sequence by the breast-imaging community. We investigated whether DWI could be used as a substitute DP. MATERIAL AND METHODS: One hundred thirty-two consecutive patients with equivocal or suspicious findings at ultrasound and/or mammography received a full diagnostic breast MRI according to international recommendations. Histopathological verification served as reference standard. We evaluated three sections of the MRI protocol: IP, DP, and apparent diffusion coefficient (ADC) maps derived from DWI. Circular ROIs (regions of interest, mean size 5-10 mm2) were drawn into the enhancing parts of the lesion (first postcontrast). ROIs were transferred to the corresponding location on ADC maps and IP and DP images. Mean ROI values were investigated signal intensity (SI): (1) Initial-phase enhancement = (SI(IP) - SI(precontrast))/SI(precontrast); (2) Delayed-phase enhancement = (SI(DP) - SI(IP))/SI(IP); (3) ADC. Multiparametric combinations were computed using logistic regression analysis: (1) IP+: Initial-phase enhancement and ADC; (2) Curve: Initial-phase enhancement and delayed-phase enhancement; (3) Curve+: Curve and ADC. The diagnostic performances of these feature combinations to diagnose malignancy were compared by the area under the receiver-operating characteristics curve (AUC). RESULTS: One hundred thirty-two patients (age: mean = 57.1 years, range 23-83 years) with 145 lesions were included (malignant/benign 101/44). IP+ (AUC = 0.877) outperformed Curve (AUC = 0.788, p = 0.03). Curve+ was not superior to IP+ (p = 1). CONCLUSION: DWI could substitute DP. Because DWI is typically used as an add-on to IP and DP, our results might help to abbreviate and to simplify current practice of breast MRI. KEY POINTS: • DWI provides similar but superior diagnostic information for diagnosis of malignancy in enhancing breast lesions compared to DP. • Adding DP to DWI does not provide incremental information to distinguish benign from malignant lesions. • DWI could substitute DP. As DWI is typically used as an add-on to IP and DP, our findings might help to abbreviate and to simplify current breast MRI practice.
EVALuna2:210908

Breast MRI texture analysis for prediction of BRCA-associated genetic risk - Vasileiou, Georgia; Costa, Maria J.; Long, Christopher; Wetzler, Iris; Hoyer, Juliane; Kraus, Cornelia; Popp, Bernt; Emons, Julius; Wunderle, Marius; Wenkel, Evelyn; Uder, Michael; Beckmann, Matthias; et al. (BMC Medical Imaging, 2020)
BACKGROUND: BRCA1/2 deleterious variants account for most of the hereditary breast and ovarian cancer cases. Prediction models and guidelines for the assessment of genetic risk rely heavily on criteria with high variability such as family cancer history. Here we investigated the efficacy of MRI (magnetic resonance imaging) texture features as a predictor for BRCA mutation status. METHODS: A total of 41 female breast cancer individuals at high genetic risk, sixteen with a BRCA1/2 pathogenic variant and twenty five controls were included. From each MRI 4225 computer-extracted voxels were analyzed. Non-imaging features including clinical, family cancer history variables and triple negative receptor status (TNBC) were complementarily used. Lasso-principal component regression (L-PCR) analysis was implemented to compare the predictive performance, assessed as area under the curve (AUC), when imaging features were used, and lasso logistic regression or conventional logistic regression for the remaining analyses. RESULTS: Lasso-selected imaging principal components showed the highest predictive value (AUC 0.86), surpassing family cancer history. Clinical variables comprising age at disease onset and bilateral breast cancer yielded a relatively poor AUC ( 0.56). Combination of imaging with the non-imaging variables led to an improvement of predictive performance in all analyses, with TNBC along with the imaging components yielding the highest AUC (0.94). Replacing family history variables with imaging components yielded an improvement of classification performance of 4%, suggesting that imaging compensates the predictive information arising from family cancer structure. CONCLUSIONS: The L-PCR model uncovered evidence for the utility of MRI texture features in distinguishing between BRCA1/2 positive and negative high-risk breast cancer individuals, which may suggest value to diagnostic routine. Integration of computer-extracted texture analysis from MRI modalities in prediction models and inclusion criteria might play a role in reducing false positives or missed cases especially when established risk variables such as family history are missing.
CRIS-Team Scopus Importer:2020-08-07
Keywords: BRCA1/2; Breast cancer; HBOC; L-PCR; MRI; Texture analysis

Breast volume assessment with a smart phone device compared to MRI - Behrens, Annika; Wunderle, Marius; Häberle, Lothar; Stamminger, Marc; Zint, Daniel; Emons, Julius; Heindl, Felix; Hack, Caroline; Ohlmeyer, Sabine; Uder, Michael; Beckmann, Matthias; Fasching, Peter (GEBURTSHILFE UND FRAUENHEILKUNDE, 2022)
CRIS-Team WoS Importer:2022-11-04

Brief Report: Association of Quantitative and Topographic Assessment of Heberden's Nodes With Knee Osteoarthritis: Data From the Osteoarthritis Initiative - Kumar, Neil M.; Hafezi-Nejad, Nima; Guermazi, Ali; Haj-Mirzaian, Arya; Haugen, Ida K.; Roemer, Frank; Demehri, Shadpour (Arthritis and Rheumatology, 2018)
OBJECTIVE: To determine whether the presence, number, and topography (digit location and symmetry) of Heberden's nodes are associated with the incidence and progression of radiographic osteoarthritis (OA) of the knee. METHODS: We analyzed 8,023 knees (with 8 years of follow-up) from the Osteoarthritis Initiative. Cox regression was performed on Heberden's node presence, total number, location, and symmetry (using 2 symmetry index models) obtained at baseline physical examination as well as self-report of Heberden's node presence for evaluation of association with radiographic knee OA incidence (development of a Kellgren/Lawrence grade of ≥2) and progression (worsening in the medial joint space narrowing score of ≥1). Covariate adjustments relevant to OA outcomes were performed. RESULTS: The presence of Heberden's nodes (in 64% of the subjects) at baseline physical examinations, but not subjective self-report of Heberden's nodes, was associated with radiographic knee OA incidence (hazard ratio [HR] 1.19 and 95% confidence interval [95% CI] 1.001-1.402 [approached statistical significance]). Each additional Heberden's node found on physical examination was associated with knee OA incidence (HR 1.03 [95% CI 1.000-1.054] [approached statistical significance]) and progression (HR 1.04 [95% CI 1.016-1.063]). Knee OA incidence and progression were associated with Heberden's nodes located on the third digit (HR 1.26 [95% CI 1.068-1.487] and 1.18 [95% CI 1.019-1.361], respectively) and first digit (HR 1.186 [95% CI 0.992-1.418] [approached statistical significance] and HR 1.26 [95% CI 1.084-1.453], respectively). Heberden's node symmetry was associated with knee OA incidence (model 1 HR 1.09 [95% CI 0.997-1.185] [approached statistical significance]) and progression (model 2 HR 1.13 [95% CI 1.035-1.234]). CONCLUSION: The number of Heberden's nodes, their locations, and symmetry were associated with knee OA incidence and progression over 8 years.
EVALuna2:35360

Brief Report: Cartilage Thickness Change as an Imaging Biomarker of Knee Osteoarthritis Progression: Data From the Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium - Eckstein, Felix; Collins, J. E.; Nevitt, M. C.; Lynch, J. A.; Kraus, V. B.; Katz, J. N.; Losina, E.; Wirth, Wolfgang; Guermazi, A.; Roemer, Frank; Hunter, D. J. (Arthritis and Rheumatology, 2015)
To investigate the association of cartilage thickness change over 24 months, as determined by magnetic resonance imaging (MRI), with knee osteoarthritis (OA) progression at 24-48 months.This nested case-control study included 600 knees with a baseline Kellgren/Lawrence (K/L) grade of 1-3 from 600 Osteoarthritis Initiative (OAI) participants. Case knees (n = 194) had both medial tibiofemoral radiographic joint space loss (>=0.7 mm) and a persistent increase in the Western Ontario and McMaster Universities Osteoarthritis Index pain score (>=9 on a 0-100 scale) 24-48 months from baseline. Control knees (n = 406) included 200 with neither radiographic nor pain progression, 103 with radiographic progression only, and 103 with pain progression only. Medial and lateral femorotibial cartilage was segmented from sagittal 3T MRIs at baseline, 12 months, and 24 months. Logistic regression was used to assess the association of change in cartilage thickness, with a focus on the central medial femorotibial compartment, and OA progression.Central medial femorotibial compartment thickness loss was significantly associated with case status, with an odds ratio (OR) of 1.9 (95% confidence interval [95% CI] 1.6-2.3) (P < 0.0001). Association with case status reached P < 0.05 for both the central femur (OR 1.8 [95% CI 1.5-2.2]) and the central tibia (OR 1.6 [95% CI 1.3-1.9]). Lateral femorotibial compartment cartilage thickness loss, in contrast, was not significantly associated with case status. A reduction in central medial femorotibial compartment cartilage thickness was strongly associated with radiographic progression (OR 4.0 [95% CI 2.9-5.3]; P < 0.0001) and only weakly associated with pain progression (OR 1.3 [95% CI 1.1-1.6]; P < 0.01).Our findings indicate that loss of medial femorotibial cartilage thickness over 24 months is associated with the combination of radiographic and pain progression in the knee, with a stronger association for radiographic progression.
EVALuna2:14522

Brief report: symmetricity of radiographic and MRI-detected structural joint damage in persons with knee pain - the Joints on Glucosamine (JOG) Study - Roemer, Frank; Jarraya, M.; Kwoh, C. K.; Hannon, M. J.; Boudreau, R. M.; Green, S. M.; Jakicic, J. M.; Moore, C.; Guermazi, Ali (Osteoarthritis and Cartilage, 2015)
Most MRI-based osteoarthritis (OA) studies have focused on a single knee per person and thus, data on bilaterality is sparse. Study aim was to describe symmetricity of MRI-detected OA features in a cohort of subjects with knee pain.Participants were 169 subjects with chronic knee pain who had 3 T MRI of both knees using the same protocol as in the Osteoarthritis Initiative. Knees were read for cartilage damage, bone marrow lesions (BMLs), and meniscal damage according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. Chi(2) tests were used to compare the proportion of knees with unilateral tissue pathology to the proportion what would be expected if both knees were independent. We further used percent agreement and linear weighted kappa statistics to describe agreement of cartilage damage and BMLs in the same articular plates.51.2% of participants were men, mean age was 52.1 (±6.2), mean BMI was 29.0 kg/m(2) (±4.1). All plates showed a significant higher degree of symmetricity for cartilage damage as evidenced by weighted kappas ranging from 0.32 to 0.59. For BMLs the degree of symmetricity was higher for the patella, trochlea, medial tibia, lateral femur, and medial femur; for meniscal damage the degree of unilaterality was lower for all medial meniscal subregions but not all lateral. Kappas ranged between 0.52 and 0.68 for cartilage and 0.30 and 0.55 for BMLs for the four subregions with highest agreement.A higher degree of symmetricity of tissue damage than expected by chance was observed in this cohort of subjects with knee pain.
EVALuna2:14527

BURDEN OF MRI-DETECTED PATHOLOGICAL FEATURES AND FUTURE TRAJECTORIES OF PAIN AND FUNCTION IN PARTICIPANTS WITH RADIOGRAPHIC KNEE OSTEOARTHRITIS - Westra, J.; Ashbeck, E. L.; Guermazi, A.; Roemer, Frank; Kwoh, C. K. (2017)
EVALuna2:36273

Camptocormia as the presenting symptom in sporadic late onset nemaline myopathy: A case report - Türk, Matthias; Nagel, Armin Michael; Roemer, Frank; Schlötzer-Schrehardt, Ursula; Thiel, Christian; Winterholler, Martin; Schröder, Rolf (BMC Musculoskeletal Disorders, 2019)
Background: Camptocormia has been reported in a plethora of diseases comprising disorders of the central nervous system, the peripheral nervous system, and the neuromuscular junction as well as hereditary and acquired myopathies. In sporadic late onset nemaline myopathy concomitant axial myopathy is common, but reports about camptocormia as the only presenting symptom in this condition are very rare. Notably, sporadic late onset nemaline myopathy is a potentially treatable condition in particular when associated with monoclonal gammopathy of unknown significance, HIV or rheumatological disorders. Case presentation: We report the case of a 62-year-old female patient, who presented with slowly progressive camptocormia. Comprehensive work-up including neurological work-up, laboratory tests, MR-imaging, muscle biopsy and genetic testing led to the diagnosis of sporadic late onset nemaline myopathy. Conclusions: Our case report highlights that sporadic late onset nemaline myopathy has to be considered in patients presenting with isolated camptocormia and comprehensive work-up of camptocormia is mandatory to ascertain the individual diagnosis, especially in consideration of treatable conditions.
CRIS-Team Scopus Importer:2019-12-03
Keywords: Axial myopathy; Camptocormia; Muscle biopsy; Nemaline rods; SLONM; Sporadic late onset nemaline myopathy

Can a Clinical Examination Demonstrate Intramuscular Tendon Involvement in Acute Hamstring Injuries? - Crema, Michel D.; Guermazi, Ali; Reurink, Gustaaf; Roemer, Frank; Maas, Mario; Weir, Adam; Moen, Maarten H.; Goudswaard, Gert J.; Tol, Johannes L. (Orthopaedic Journal of Sports Medicine, 2017)
Background: Involvement of the intramuscular (central) tendon in acute hamstring injuries, as detected on magnetic resonance imaging (MRI), may prolong recovery times. To date, it is unclear whether hamstring injuries exhibiting intramuscular tendon involvement can be identified though routine clinical examinations that assess flexibility and strength. Purpose: To test whether MRI-detected intramuscular tendon involvement could be identified by a clinical assessment of muscle strength and flexibility. Study Design: Case-control study; Level of evidence, 3. Methods: Participants were drawn from a multicenter randomized controlled trial on the effect of platelet-rich plasma in acute hamstring injuries. Clinical parameters assessed within 5 days of injury were active knee extension and passive straight-leg raise for hamstring flexibility and isometric knee flexion force with 15° and 90° of knee flexion. Also, 1.5-T MRI of the thigh was performed within 5 days of injury and was evaluated for the presence of different types of intramuscular tendon involvement. One-way analysis of variance was used to determine whether clinical parameters could discriminate injuries with intramuscular tendon involvement from those without such involvement. Results: A total of 74 acute hamstring injuries were included, with 52 (70.3%) injuries affecting the myotendinous junction. Injuries exhibiting intramuscular tendon discontinuity on MRI had an increased mean absolute flexibility deficit for active knee extension (20.4° ± 14.9° vs 10.7° ± 9.0°, respectively; P = .006) and decreased mean strength at 15° (62.2 ± 26.7 N vs 76.6 ± 22.5 N, respectively; P = .05) compared with injuries without intramuscular tendon discontinuity. Flexibility and strength showed major overlap and variance among injuries with and without intramuscular tendon involvement. Conclusion: Hamstring flexibility and strength cannot be used to discriminate the presence of intramuscular tendon involvement.
EVALuna2:34711

Can flat-detector CT after successful endovascular treatment predict long-term outcome in patients with large vessel occlusion? An Alberta Stroke Programme Early CT Score–based study - Knott, Michael; Hölter, Philip; Hock, Stefan; Mühlen, Iris; Gerner, Stefan; Sprügel, Maximilian; Huttner, Hagen; Schwab, Stefan; Engelhorn, Tobias; Dörfler, Arnd (Neurological Sciences, 2022)
Purpose: Recent studies postulate a high prognostic value of the Alberta Stroke Programme Early CT Score (ASPECTS) applied on non-contrast whole-brain flat-detector CT (FDCT) after successful endovascular treatment (EVT). The aim of this study was the evaluation of long-term patient outcome after endovascular treatment using postinterventional FDCT. Methods: Using a local database (Stroke Research Consortium in Northern Bavaria, STAMINA), 517 patients with successful endovascular treatment (modified Thrombolysis in Cerebral Infarction (mTICI) ≥ 2B) due to acute ischaemic stroke (AIS) and large vessel occlusion (LVO) of the anterior circulation were recruited retrospectively. In all cases, non-contrast FDCT after EVT was analysed with special focus at ASPECTS. These results were correlated with the functional outcome in long-term (modified Rankin Scale (mRS) shift from pre-stroke to 90 days after discharge). Results: A significant difference in FDCT-ASPECTS compared to the subgroup of favourable vs. unfavourable outcome (Δ mRS) (median ASPECTS 10 (10–9) vs. median ASPECTS 9 (10–7); p = 0,001) could be demonstrated. Multivariable regression analysis revealed FDCT-ASPECTS (OR 0.234, 95% CI − 0.102–0.008, p = 0.022) along with the NHISS at admission (OR 0.169, 95% CI 0.003–0.018, p = 0.008) as independent factors for a favourable outcome. Cut-off point for a favourable outcome (Δ mRS) was identified at an ASPECTS ≥ 8 (sensitivity 90.6%, specificity 35%). Conclusion: For patients with LVO and successful EVT, FDCT-ASPECTS was found to be highly reliable in predicting long-term outcome.
CRIS-Team Scopus Importer:2022-12-02
Keywords: ASPECTS; Endovascular treatment; Flat-detector CT; Stroke

Can intracranial time-of-flight-MR angiography predict extracranial carotid artery stenosis? - Osmanodja, Filiz; Scheitz, Jan F.; Fiebach, Jochen B.; Ganeshan, Ramanan; Villringer, Kersten (Journal of Neurology, 2021)
Objectives Extracranial stenosis of the internal carotid artery (ICA) is an important cause of ischemic stroke and transient ischemic attack (TIA). It can be diagnosed using contrast-enhanced CT or MR angiography (MRA) as well as Doppler ultrasound. In this study, we assessed the diagnostic value of intracranial time-of-flight (TOF) MRA to predict extracranial ICA stenosis (ICAS). Methods We retrospectively analyzed consecutive patients with acute ischemic stroke or TIA and middle- (50-69%) or high-grade (70-99%) unilateral extracranial ICAS according to NASCET criteria assessed by ultrasound between January 2016 and August 2018. The control group consisted of patients without extracranial ICAS. Intraluminal signal intensities (SI) of the intracranial ICA on the side of the extracranial stenosis were compared to the contralesional side on TOF-MRA source images. SI ratios (SIR) of contralesional:lesional side were compared between groups. Results In total, 151 patients were included in the main analysis. Contralesional:lesional SIR in the intracranial C4-segment was significantly higher in patients with ipsilateral extracranial ICA stenosis (n = 51, median 74 years, 57% male) compared to the control group (n = 100, median 68 years, 48% male). Mean SIR was 1.463 vs. 1.035 (p < 0.001) for right-sided stenosis and 1.362 vs. 1.000 (p < 0.001) for left-sided stenosis. Receiver-operating characteristic curve demonstrated a cut-off value of 1.086 for right-sided [sensitivity/specificity 75%/81%; area under the curve (AUC) 0.81] and 1.104 for left-sided stenosis (sensitivity/specificity 70%/84%; AUC 0.80) in C4 as a good predictor for high-grade extracranial ICAS. Conclusions SIR on TOF-MRA can be a marker of extracranial ICAS.
CRIS-Team WoS Importer:2021-11-19

Can Perfusion-Based Brain Tissue Oxygenation MRI Support the Understanding of Cerebral Abscesses In Vivo? - Knott, Michael; Hölter, Philip; Soder, Liam; Schlaffer, Sven-Martin; Hoffmanns, Sophia; Lang, Roland; Dörfler, Arnd; Schmidt, Manuel (Diagnostics, 2023)
Purpose: The clinical condition of a brain abscess is a potentially life-threatening disease. The combination of MRI-based imaging, surgical therapy and microbiological analysis is critical for the treatment and convalescence of the individual patient. The aim of this study was to evaluate brain tissue oxygenation measured with dynamic susceptibility contrast perfusion weighted imaging (DSC-PWI) in patients with brain abscess and its potential benefit for a better understanding of the environment in and around brain abscesses. Methods: Using a local database, 34 patients (with 45 abscesses) with brain abscesses treated between January 2013 and March 2021 were retrospectively included in this study. DSC-PWI imaging and microbiological work-up were key inclusion criteria. These data were analysed regarding a correlation between DSC-PWI and microbiological result by quantifying brain tissue oxygenation in the abscess itself, the abscess capsula and the surrounding oedema and by using six different parameters (CBF, CBV, CMRO2, COV, CTH and OEF). Results: Relative cerebral blood flow (0.335 [0.18–0.613] vs. 0.81 [0.49–1.08], p = 0.015), relative cerebral blood volume (0.44 [0.203–0.72] vs. 0.87 [0.67–1.2], p = 0.018) and regional cerebral metabolic rate for oxygen (0.37 [0.208–0.695] vs. 0.82 [0.55–1.19], p = 0.022) were significantly lower in the oedema around abscesses without microbiological evidence of a specific bacteria in comparison with microbiological positive lesions. Conclusions: The results of this study indicate a relationship between brain tissue oxygenation status in DSC-PWI and microbiological/inflammatory status. These results may help to better understand the in vivo environment of brain abscesses and support future therapeutic decisions.
CRIS-Team Scopus Importer:2023-11-24
Keywords: brain abscess; brain tissue oxygenation; DSC-PWI

Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings? - Serner, Andreas; Weir, Adam; Tol, Johannes L.; Thorborg, Kristian; Roemer, Frank; Guermazi, Ali; Holmich, Per (British Journal of Sports Medicine, 2016)
Little is known about the value of clinical examination in relation to diagnostic imaging for acute groin injuries in athletes. Primary aim: to investigate whether clinical examination tests predict a positive or negative MRI result (MRI±). Secondary aim: to assess accuracy of clinical tests to localise injury in MRI+ cases.We consecutively included 81 male athletes with acute groin injuries. Standardised clinical examination (palpation, resistance and stretch tests) and MRI were performed within 7 days of injury. Diagnostic statistics including positive and negative predictive values (PPV/NPV) were calculated.85 acute injuries were found on MRI in 64 (79%) athletes with 17 (21%) athletes having MRI- injuries. Palpation had the highest NPV (91-96%, (95% CI 69% to 99%)). 3 specific adductor examination tests (resisted outer range adduction, squeeze test with hip neutral and long lever, and passive adductor stretch) showed 80-81% (95% CI 63% to 91%) probability of an MRI+ adductor lesion when positive, all with high accuracy of a correct MRI location (PPV 93-97% (95% CI 76% to 100%)). Hip flexor tests showed poor ability to predict MRI+ lesions (PPV 34-63% (95% CI 20% to 84%)) and low accuracy (PPV 17-71% (95% CI 7% to 85%)).21% of athletes had negative imaging and the absence of palpation pain was best at predicting an MRI- result. Specific adductor examination tests accurately predicted MRI+ adductor injuries. Hip flexor clinical tests were poor at predicating and localising MRI+ injuries in the hip flexors. Clinical examination appears sufficient to diagnose acute adductor injuries, whereas MRI could assist in accurately locating acute hip flexor injuries.
EVALuna2:14666

Can structural joint damage measured with MR imaging be used to predict knee replacement in the following year? - Roemer, Frank; Kwoh, C. Kent; Hannon, Michael J.; Hunter, David J.; Eckstein, Felix; Wang, Zhijie; Boudreau, Robert M.; John, Markus R.; Nevitt, Michael C.; Guermazi, Ali (Radiology, 2015)
To assess whether magnetic resonance (MR) imaging-based cross-sectional measures of structural joint damage can be used to predict knee replacement during the following year.Participants were drawn from the Osteoarthritis Initiative, a longitudinal observational study that includes 4796 participants who have knee osteoarthritis or are at risk. The HIPAA-compliant protocol was approved by the institutional review boards of all participating centers, and written informed consent was obtained from all participants. During the 5 years of follow-up, 199 knees underwent knee replacement and were matched with 199 control knees that did not undergo knee replacement. Knees were matched according to radiographic disease stage and patient sex and age. All knees that underwent knee replacement and had MR images available from the year before surgery were included. MR images were assessed for cartilage damage, bone marrow lesions, meniscal damage, meniscal extrusion, synovitis, and effusion prior to reported knee replacement. Conditional logistic regression was applied to assess the risk of knee replacement. Analyses were performed on a compartmental and knee level.Participants had a mean age ± standard deviation of 64.2 years ± 8.4 (range, 47-82 years) and were predominantly women (232 of 398 participants, 58.3%). Risk for knee replacement was significantly increased for knees that exhibited two or more subregions with severe cartilage loss (odds ratio [OR], 16.5; 95% confidence interval [CI]: 3.96, 68.76), more than two subregions with bone marrow lesions (OR, 4.00; 95% CI: 1.75, 9.16), medial meniscal maceration (OR, 1.84; 95% CI: 1.13, 2.99), effusion (OR, 4.75; 95% CI: 2.55, 8.85), or synovitis (OR, 2.17; 95% CI: 1.33, 3.56), but not extrusion (OR, 1.00; 95% CI: 0.60,1.67), when compared with knees that did not exhibit these features as the reference standard.Apart from meniscal extrusion, all features of tissue abnormalities at MR imaging were related to clinical prognosis and could be used to predict knee replacement in the following year.
EVALuna2:14482

Can the documented patient briefing be carried out with an iPad App? - Schlechtweg, Philipp; Hammon, Matthias; Heberlein, Christian; Giese, David Andreas; Uder, Michael; Schwab, Siegfried (Journal of Digital Imaging, 2013)
To evaluate the feasibility of an iPad-based documented patient briefing for Magnetic Resonance Imaging (MRI) examinations. A standard briefing sheet and questionnaire for a MRI scan was converted from paper form into an iPad application. Twenty patients, who had been referred for an MRI scan, were briefed about the examination in paper form as well as via the iPad application before performing the MRI scan. Time each patient needed for the briefing and the number of questions that came up were documented. Patients' acceptance of the electronic briefing was assessed using a questionnaire. The mean processing time was 2.36 min (range 0.58 to 09.35 min., standard deviation ±2.05 min) for the paper-based briefing and 4.15 min (range 1.56 to 13.48 min, SD ± 2.36 min) for the app-based briefing. Concerning technical aspects, patients asked two questions during the app-based briefing; no questions arose during the paper-based briefing. Six patients preferred electronic briefing and four patients, the paper-based form. No patient preferred the electronic form with additional multimedial information. Eight participants did not mind which briefing version was used; two participants did not express their preference at all. Our experiences showed that electronic briefing using an iPad is feasible and has the potential to become a user-friendly alternative to the conventional paper-based approach. Owing to the broad range of the results, a follow-up study will seek to determine the influencing factors on processing time and other potential questions. © 2012 Society for Imaging Informatics in Medicine.
CRIS-Team Scopus Importer:2023-03-08
Keywords: App; Apple; Electronic patient consent; Feasibility; iPad; Tablet PC

Cardiac MRI: An Alternative Method to Determine the Left Ventricular Function - Michler, Kerstin; Hessman, Christopher; Prümmer, Marcus; Achenbach, Stephan; Uder, Michael; Janka, Rolf Matthias (Diagnostics, 2023)
(1) Background: With the conventional contour surface method (KfM) for the evaluation of cardiac function parameters, the papillary muscle is considered to be part of the left ventricular volume. This systematic error can be avoided with a relatively easy-to-implement pixel-based evaluation method (PbM). The objective of this thesis is to compare the KfM and the PbM with regard to their difference due to papillary muscle volume exclusion. (2) Material and Methods: In the retrospective study, 191 cardiac-MR image data sets (126 male, 65 female; median age 51 years; age distribution 20–75 years) were analysed. The left ventricular function parameters: end-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF) and stroke volume (SV) were determined using classical KfW (syngo.via and cvi42 = gold standard) and PbM. Papillary muscle volume was calculated and segmented automatically via cvi42. The time required for evaluation with the PbM was collected. (3) Results: The size of EDV was 177 mL (69–444.5 mL) [average, [minimum–maximum]], ESV was 87 mL (20–361.4 mL), SV was 88 mL and EF was 50% (13–80%) in the pixel-based evaluation. The corresponding values with cvi42 were EDV 193 mL (89–476 mL), ESV 101 mL (34–411 mL), SV 90 mL and EF 45% (12–73%) and syngo.via: EDV 188 mL (74–447 mL), ESV 99 mL (29–358 mL), SV 89 mL (27–176 mL) and EF 47% (13–84%). The comparison between the PbM and KfM showed a negative difference for end-diastolic volume, a negative difference for end-systolic volume and a positive difference for ejection fraction. No difference was seen in stroke volume. The mean papillary muscle volume was calculated to be 14.2 mL. The evaluation with PbM took an average of 2:02 min. (4) Conclusion: PbM is easy and fast to perform for the determination of left ventricular cardiac function. It provides comparable results to the established disc/contour area method in terms of stroke volume and measures “true” left ventricular cardiac function while omitting the papillary muscles. This results in an average 6% higher ejection fraction, which can have a significant influence on therapy decisions.
CRIS-Team Scopus Importer:2023-05-05
Keywords: cardiac MRI; cine MRI; ejection fraction; left ventricular function; MRI

Cardiac MRI in Children and Adolescents Who Have Undergone Surgical Repair of Right-Sided Congenital Heart Disease: Automated Left Ventricular Volumes and Function Analysis and Effects of Different Manual Adjustments - Rompel, O.; Janka, Rolf Matthias; May, Matthias; Glöckler, Martin; Cesnjevar, Robert; Dittrich, Sven; Lell, Michael; Uder, Michael; Hammon, Matthias (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2015)
Purpose: To evaluate automated segmentation and the effects of different manual adjustments regarding left ventricular parameter quantification in cardiac magnetic resonance (MR) data on children and adolescents who have undergone surgical repair of right-sided congenital heart disease (CHD). Materials and Methods: Dedicated software (syngo.via, Siemens AG) was used to automatically segment and/or manually adjust the end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), myocardial mass (MM) and ejection fraction (EF) before/after manual apex/base adjustment (ADJ-step 1) and after manual apex/base/myocardial contour adjustment (ADJ-step 2; reference standard). MR data of 40 patients (13.1 ± 3.1y, 4 - 17y) with repaired CHD with decreased pulmonary blood flow (CHD-DPBF) were evaluated. Intra- and inter-rater reliability was determined for 10 randomly selected patients. Results: The software correctly detected the left ventricle in 38/40 (95 %) patients. EDV after automated segmentation: 119.1 ± 44.0ml; after ADJ-step 1: 115.8 ± 39.5ml; after ADJ-step 2: 116.2 ± 39.4 ml. The corresponding results for ESV were 52.0 ± 18.5/49.6 ± 16.9/49.7 ± 16.4ml; for SV 67.1 ± 28.5/66.2 ± 25.4/66.5 ± 25.5ml; for EF 55.5 ± 7.3/56.7 ± 6.6/56.7 ± 6.3 %; for MM 83.7 ± 35.9/76.2 ± 28.3/74.6 ± 27.2 g. Significant differences were found for ESV/MM/EF comparing the automated segmentation results with these after ADJ-step 1 and ADJ-step 2. No significant differences were found when comparing all results of ADJ-step 1 and ADJ-step 2 or when comparing EDV/SV results. Intra- and inter-rater reliability was excellent. The mean time effort was 63.4 ± 6.9 s for the automated segmentation, 74.2 ± 8.9 s for ADJ-step 1 and 269.5 ± 39.4 s for ADJ-step 2. Conclusion: Automated left ventricular volumes and function analysis in children and adolescents with surgically treated CHD proved to be feasible with excellent intra- and inter-rater reliability. Automated segmentation with manual apex/base adjustment provided clinically acceptable results. Key Points: o?Automated left ventricular volume and function analysis in children and adolescents with surgically treated right-sided heart disease is feasible with excellent intra- and inter-rater reliability.o?Automated segmentation with manual apex/base adjustment provides clinically acceptable results.o?Additional manual myocardial contour adjustment does not significantly improve the results. Citation Format: o?Rompel O, Janka R, May MS et al. Cardiac MRI in Children and Adolescents Who Have Undergone Surgical Repair of Right-Sided Congenital Heart Disease: Automated Left Ventricular Volumes and Function Analysis and Effects of Different Manual Adjustments. Fortschr Röntgenstr 2015; 187: 1099 - 1107.
EVALuna2:14516

Cardiac Phenotype and Tissue Sodium Content in Adolescents with Defects in the Melanocortin System - Puder, Lia; Roth, Sophie; Krabusch, Philipp; Wiegand, Susanna; Opitz, Robert; Bald, Martin; Flück, Christa; Schulz, Esther; Voss, Egbert; Markó, Lajos; Linz, Peter; Berger, Felix; et al. (Journal of Clinical Endocrinology and Metabolism, 2021)
Context: Pro-opiomelanocortin (POMC) and the melanocortin-4 receptor (MC4R) play a pivotal role in the leptin-melanocortin pathway. Mutations in these genes lead to monogenic types of obesity due to severe hyperphagia. In addition to dietary-induced obesity, a cardiac phenotype without hypertrophy has been identified in MC4R knockout mice. Objective: We aimed to characterize cardiac morphology and function as well as tissue Na+ content in humans with mutations in POMC and MC4R genes. Methods: A cohort of 42 patients (5 patients with bi-allelic POMC mutations, 6 heterozygous MC4R mutation carriers, 19 obese controls without known monogenic cause, and 12 normal weight controls) underwent cardiac magnetic resonance (CMR) imaging and 23Na-MRI. Results: Monogenic obese patients with POMC or MC4R mutation respectively had a significantly lower left ventricular mass/body surface area (BSA) than nonmonogenic obese patients. Left ventricular end-diastolic volume/BSA was significantly lower in POMC-and MC4R-deficient patients than in nonmonogenic obese patients. Subcutaneous fat and skin Na+ content was significantly higher in POMC-and MC4R-deficient patients than in nonmonogenic obese patients. In these compartments, the water content was significantly higher in patients with POMC and MC4R mutation than in control groups. Conclusion: Patients with POMC or MC4R mutations carriers had a lack of transition to hypertrophy, significantly lower cardiac muscle mass/BSA, and stored more Na+ within the subcutaneous fat tissue than nonmonogenic obese patients. The results point towards the role of the melanocortin pathway for cardiac function and tissue Na+ storage and the importance of including cardiologic assessments into the diagnostic work-up of these patients.
CRIS-Team Scopus Importer:2021-09-17
Keywords: cardiac function; left ventricular function; MC4R; melanocortin pathway; Monogenic obesity; POMC; tissue sodium content; tissue water content

Cardiac T2 mapping: Robustness and homogeneity of standardized in-line analysis - Wiesmüller, Marco; Wüst, Wolfgang; Heiß, Rafael; Treutlein, Christoph; Uder, Michael; May, Matthias (Journal of Cardiovascular Magnetic Resonance, 2020)
Background and purpose: Interpretation of T2 values remains difficult due to limited comparability across hardware and software systems and the lack of validated measurement recommendations for the number and orientation of mandatory slices. Our aims were to provide a standardized comparison of intra- and inter-individual T2 values in the short and long axes and to investigate inter-scanner reproducibility. Method and materials: Ninety cardiovascular magnetic resonance (CMR) studies in 30 healthy subjects were performed with three identical 1.5 T CMR scanners (same hardware and software) using a balanced steady-state free precession (bSSFP) gradient echo sequence in three short axis (SAx) and three long axis (LAx) views. A commercially available T2 mapping software package of the latest generation with automatic in-line motion correction was used for acquisition. Regions of interest were manually drawn in each of the 16 myocardial segments according to the American Heart Association (AHA) model in three SAx and three LAx acquisitions. Analysis of inter-scanner, inter-segmental, intra-segmental, inter-regional and inter-level differences was performed. Results: Inter-scanner reproducibility was high and the mean myocardial T2 value for all evaluated segments was 45.7 ± 3.4 ms. Significant inter-segmental variations of mean T2 values were found. Mean intra-segmental T2 values were comparable between LAx and SAx acquisitions in 72%. Significantly higher T2 values were found in apical segments and a significant disparity among different regions was found for SAx and LAx orientations. Conclusion: Standardized cardiac T2 mapping is highly reproducible on identical CMR systems. T2 values vary significantly between single heart segments, regions, levels, and axes in young, healthy subjects.
CRIS-Team Scopus Importer:2020-06-09
Keywords: Cardiovascular imaging; cardiovascular magnetic resonance; MRI; T2 mapping

Cardiac T2 star mapping: standardized inline analysis of long and short axis at three identical 1.5 T MRI scanners - Heiß, Rafael; Wiesmüller, Marco; Treutlein, Christoph; Seuß, Hannes; Uder, Michael; May, Matthias; Wüst, Wolfgang (International Journal of Cardiovascular Imaging, 2019)
T2 star mapping can be applied for in vivo cardiac iron quantification. Current recommendations of imaging acquisition, post-processing and interpretation of normal values are based on old scanner types and in house software packages. A standardized comparison of short (SAX) and long axis (LAX) segments using commercially available software packages and modern scanners is lacking. To provide a standardized comparison of T2 star time values in SAX and LAX and to investigate intersegmental, interregional and inter-level comparison and the interscanner reproducibility. 84 cardiac MRIs in 28 healthy volunteers were performed with three structurally identical 1.5 T MRI scanners. A commercially available software package for T2 star mapping with automatic in-line motion correction was used for analysis. Regions of interest were manually placed in each of the 16 myocardial segments according to the AHA model in three SAX and three LAX. A total of 2856 ROIs were drawn and 102 segments per volunteer were analysed. Interscanner reproducibility was high (91%) and the mean myocardial T2 star time value for all evaluated segments was 34 ± 5.7 ms. No significant difference was found between all measurements in SAX (35 ± 5.5 ms) and LAX (34 ± 5.8 ms). T2 star time values varied significantly between heart segments in the same axis and in 44% between corresponding SAX and LAX segments. T2 star time values in SAX and LAX have a high interscanner reproducibility but can vary significantly between heart segments in the same axis. Comparability between corresponding SAX and LAX segments is limited. To get representative results T2 star time values should be obtained in more than one heart segment and for follow-up studies identical segments should be used to avoid a systematic bias.
EVALuna2:210886

Cardiomyopathy in Duchenne Muscular Dystrophy: Current Value of Clinical, Electrophysiological and Imaging Findings in Children and Teenagers - Dittrich, Sven; Türk, Matthias; Haaker, G.; Greim, V.; Buchholz, A.; Burkhardt, B.; Fujak, A.; Trollmann, Regina; Schmid, Andrea; Schröder, Rolf (Klinische Pädiatrie, 2015)
Progressive cardiomyopathy (CMP) is one main cause of death in DMD. This cross-sectional assessment of different cardiac diagnostic procedures focusses on preterm diagnosis of cardiac dysfunction.39 male DMD patients aged 6-20 years were included. 6 patients were still ambulatory, 21 patients received corticosteroid therapy.All patients were investigated by ECG, Holter ECG and heart rate variability (HRV), B-type natriuretic peptide (BNP), echocardiography (TTE), tissue Doppler Imaging (TD) and magnetic resonance imaging (MRI) with Late Gadolinium enhancement (LE) and segmental wall motion analysis (WMA).56% of the patients showed repolarization abnormalities and 76% altered HRV. Subnormal ventricular function was found in 25% by TTE and in 34% by MRI. TD differed from normal controls only in the apical septum. In MRI 89% of the patients showed different distribution and intensity of LE and WM restriction. The extent of LE was less in patients after steroid treatment (p<0.05).MRI with segmental LE- and WM-analysis seems to be superior to TTE and TD in exploring regional distribution and severity of damage of the myocardium. ECG and HRV abnormalities are common in DMD-patients but not tightly predictive for segmental and global left ventricular dysfunction. Targeted treatment of CMP in DMD needs prospective evaluation.A timely cardiac MRI is the most sensitive investigation for the identification of early myocardial changes in DMD which is a prerequisite for early interventions and therapeutic strategies.
EVALuna2:7289

Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial - Schöffl, Isabelle; Raming, Roman; Tratzky, Jan Philipp; Regensburger, Adrian; Kraus, Calvin; Wällisch, Wolfgang; Trollmann, Regina; Wölfle, Joachim; Dittrich, Sven; Heiß, Rafael; Knieling, Ferdinand; Weigelt, Annika (European Journal of Pediatrics, 2024)
Recently, the importance of post-COVID-19 in children has been recognized in surveys and retrospective chart analysis. However, objective data in the form of cardiopulmonary exercise test as performed in adults suffering from this condition are still lacking. This study aimed to investigate the cardiopulmonary effects of post-COVID-19 on children and adolescents. In this cross-sectional study (the FASCINATE study), children fulfilling the criteria of post-COVID-19 and an age- and sex-matched control group underwent cardiopulmonary exercise testing on a treadmill and completed a questionnaire with regard to physical activity before, during and after the infection with SARS-CoV-2. We were able to recruit 20 children suffering from post-COVID-19 (mean age 12.8 ± 2.4 years, 60% females) and 28 control children (mean age 11.7 ± 3.5 years, 50% females). All participants completed a maximal treadmill test with a significantly lower V ˙ O 2peak in the post-COVID-19 group (37.4 ± 8.8 ml/kg/min vs. 43.0 ± 6.7 ml/kg/min. p = 0.019). This significance did not persist when comparing the achieved percentage of predicted V ˙ O 2peak . There were no significant differences for oxygen pulse, heart rate, minute ventilation or breathing frequency. Conclusion: This is the first study to investigate post-COVID-19 in children using the cardiopulmonary exercise test. Although there was a significantly reduced V ˙ O 2peak in the post-COVID-19 group, this was not true for the percent of predicted values. No pathological findings with respect to cardiac or pulmonary functions could be discerned. Deconditioning was the most plausible cause for the experienced symptoms. Trial registration: clinicaltrials.gov, NCT054445531, Low-field Magnetic Resonance Imaging in Pediatric Post Covid-19—Full Text View—ClinicalTrials.gov. What is Known: • The persistence of symptoms after an infection with SARS-CoV 2, so-called post-COVID-19 exists also in children. • So far little research has been conducted to analyze this entity in the pediatric population. What is New: • This is the first study proving a significantly lower cardiopulmonary function in pediatric patients suffering from post-COVID-19 symptoms. • The cardiac and pulmonary function appear similar between children suffering from post-COVID-19 and those who don’t, but the peripheral muscles seem affected.
CRIS-Team Scopus Importer:2024-01-19
Keywords: Cardiopulmonary exercise testing; Exercise capacity; Fitness; Physical activity; Post-COVID; VO

Cardiorenal 23Na MRI at 7.0 Tesla using a 4/4 channel 1H/23Na RF antenna array - Boehmert, Laura; Kuehne, Andre; Waiczies, Helmar; Wenz, Daniel; Eigentler, Thomas Wilhelm; Funk, Stephanie; von Knobelsdorff-Brenkenhoff, Florian; Schulz-Menger, Jeanette; Nagel, Armin Michael; Seeliger, Erdmann; Niendorf, Thoralf (Magnetic Resonance in Medicine, 2019)
Purpose: Cardiorenal syndrome describes disorders of the heart and the kidneys in which a dysfunction of 1 organ induces a dysfunction in the other. This work describes the design, evaluation, and application of a 4/4-channel hydrogen-1/sodium (1H/23Na) RF array tailored for cardiorenal MRI at 7.0 Tesla (T) for a better physiometabolic understanding of cardiorenal syndrome. Methods: The dual-frequency RF array is composed of a planar posterior section and a modestly curved anterior section, each section consisting of 2 loop elements tailored for 23Na MR and 2 loopole-type elements customized for 1H MR. Numerical electromagnetic field and specific absorption rate simulations were carried out. Transmission field (B+1) uniformity was optimized and benchmarked against electromagnetic field simulations. An in vivo feasibility study was performed. Results: The proposed array exhibits sufficient RF characteristics, B+1 homogeneity, and penetration depth to perform 23Na MRI of the heart and kidney at 7.0 T. The mean B+1 field for sodium in the heart is 7.7 ± 0.8 µT/√kW and in the kidney is 6.9 ± 2.3 µT/√kW. The suitability of the RF array for 23Na MRI was demonstrated in healthy subjects (acquisition time for 23Na MRI: 18 min; nominal isotropic spatial resolution: 5 mm [kidney] and 6 mm [heart]). Conclusion: This work provides encouragement for further explorations into densely packed multichannel transceiver arrays tailored for 23Na MRI of the heart and kidney. Equipped with this technology, the ability to probe sodium concentration in the heart and kidney in vivo using 23Na MRI stands to make a critical contribution to deciphering the complex interactions between both organs.
CRIS-Team Scopus Importer:2019-07-12
Keywords: cardiac MRI; cardiorenal syndrome; MRI; renal MRI; RF coil; sodium

C-Arm Conebeam CT Perfusion Imaging in the Angiographic Suite: A Comparison with Multidetector CT Perfusion Imaging - Niu, K.; Yang, P.; Wu, Y.; Struffert, Tobias; Dörfler, Arnd; Schafer, S.; Royalty, K.; Strother, C.; Chen, G. -H. (American Journal of Neuroradiology, 2016)
BACKGROUND AND PURPOSE: Perfusion imaging in the angiography suite may provide a way to reduce time from stroke onset to endovascular revascularization of patients with large-vessel occlusion. Our purpose was to compare conebeam CT perfusion with multidetector CT perfusion. MATERIALS AND METHODS: Data from 7 subjects with both multidetector CT perfusion and conebeam CT perfusion were retrospectively processed and analyzed. Two algorithms were used to enhance temporal resolution and temporal sampling density and reduce the noise of conebeam CT data before generating perfusion maps. Two readers performed qualitative image-quality evaluation on maps by using a 5-point scale. ROIs indicating CBF/CBV abnormalities were drawn. Quantitative analyses were performed by using the Sørensen-Dice coefficients to quantify the similarity of abnormalities. A noninferiority hypothesis was tested to compare conebeam CT perfusion against multidetector CT perfusion. RESULTS: Average image-quality scores for multidetector CT perfusion and conebeam CT perfusion images were 2.4 and 2.3, respectively. The average confidence score in diagnosis was 1.4 for both multidetector CT and conebeam CT; the average confidence scores for the presence of a CBV/CBF mismatch were 1.7 (κ = 0.50) and 1.5 (κ = 0.64). For multidetector CT perfusion and conebeam CT perfusion maps, the average scores of confidence in making treatment decisions were 1.4 (κ = 0.79) and 1.3 (κ = 0.90). The area under the visual grading characteristic for the above 4 qualitative quality scores showed an average area under visual grading characteristic of 0.50, with 95% confidence level cover centered at the mean for both readers. The Sørensen-Dice coefficient for CBF maps was 0.81, and for CBV maps, 0.55. CONCLUSIONS: After postprocessing methods were applied to enhance image quality for conebeam CT perfusion maps, the conebeam CT perfusion maps were not inferior to those generated from multidetector CT perfusion.
EVALuna2:33153

Carotid artery stenting - An update Karotisstents - eine Standortbestimmung - Gölitz, Philipp; Dörfler, Arnd (Radiologe, 2013)
Clinical/methodical issue: Therapy of carotid stenosis should be based on an accurate assessment of the stenosis and a differentiation between symptomatic and asymptomatic patients. Standard radiological methods: According to current guidelines carotid artery stenting (CAS) can be considered as an established therapeutic alternative to carotid endarterectomy (CEA). Methodical innovations: For the therapy of carotid stenosis CAS has become established as a minimally invasive alternative to CEA because the complication rate has been reduced due to growing experience, technical innovations and external quality assessment. Performance: The CAS procedure should be performed in centers with documented complication rates of < 3 % for asymptomatic and < 6 % for symptomatic stenoses. Achievements: Overall there are no significant differences between CAS and CEA in the treatment of carotid stenosis concerning the secondary prophylactic effect. Practical recommendations: Ideally an interdisciplinary approach should be chosen for the therapy regime. Revascularization of asymptomatic stenoses should be considered critically as these patients might profit from optimized conservative medicinal therapy. © 2013 Springer-Verlag Berlin Heidelberg. Schlüsselwörter: Angioplastie Karotisstenose Endarteriektomie Schlaganfallprävention Stentimplantation.
CRIS-Team Scopus Importer:2022-08-05
Keywords: Angioplasty; Carotid artery stenosis; Endarterectomy; Stent deployment; Stroke prevention

Carotid CTA at the Lowest Tube Voltage (70 kV) in Comparison with Automated Tube Voltage Adaption - Eller, A.; Wiesmüller, Marco; Wüst, Wolfgang; Heiß, Rafael; Kopp, Markus; Saake, Marc; Brand, Michael; Uder, Michael; May, Matthias (American Journal of Neuroradiology, 2019)
BACKGROUND AND PURPOSE: CTA is the imaging modality of choice in many institutions for the evaluation of the supraaortic vessels, but radiation exposure remains a matter of concern. Our aim was to evaluate a 70-kV protocol for CT angiography of the carotid arteries with respect to image quality and radiation exposure compared with automated tube voltage adaption. MATERIALS AND METHODS: A total of 90 consecutive patients were included in this prospective study and randomized to the study group (n = 45, 70 kV) or control group (n = 45, automated tube voltage adaptation). Volume CT dose indices and dose-length products were recorded in the examination protocol. Image quality was assessed as arterial vessel contrast, signal-to-noise ratio, contrast-to-noise ratio, and contrast-to-noise ratio in reference to the radiation dose. Subjective overall image-quality analysis, image-artifact analysis, and diagnostic evaluation were performed by 2 observers by using a 4-point Likert scale. RESULTS: Radiation exposure was significantly lower in the study group (volume CT dose index reduced by 22%, dose-length product reduction by 20%; each P < .001). Contrast (P = .15), SNR (P = .4), and contrast-to-noise ratio (P = .5) did not show significant differences between the groups. The contrast-to-noise ratio in reference to the radiation dose was not significantly increased using the study protocol (P = .2). Subjective image quality and visualization of pathologic findings did not differ significantly between the groups. CONCLUSIONS: Carotid CTA using the lowest available voltage (70 kV) is feasible at very-low-dose levels, while overall image quality is comparable with protocols using automated tube voltage selection.
CRIS-Team Scopus Importer:2019-09-03

Carotid CTA: Radiation Exposure and Image Quality with the Use of Attenuation-Based, Automated Kilovolt Selection - Eller, A.; Wüst, Wolfgang; Kramer, Manuel; May, Matthias; Schmid, A.; Uder, Michael; Lell, Michael (American Journal of Neuroradiology, 2014)
CTA is considered the imaging modality of choice in evaluating the supraaortic vessels in many institutions, but radiation exposure remains a matter of concern. The objective of the study was to evaluate a fully automated, attenuation-based kilovolt selection algorithm in carotid CTA in respect to radiation dose and image quality compared with a standard 120-kV protocol.Ninety-eight patients were included: 53 examinations (patient age, 66 ± 12 years) were performed by use of automated adaption of tube potential (80-140 kV) on the basis of the attenuation profile of the scout scan (study group), and 45 examinations (patient age, 67 ± 11 years) were performed by use of a standard 120-kV protocol (control group). CT dose index volume and dose-length product were recorded from the examination protocol. Image quality was assessed by ROI measurements and calculations of SNR and contrast-to-noise ratio. Subjective image quality was evaluated by 2 observers with the use of a 4-point scale (3, excellent; 0, not diagnostic).Subjective image quality was rated as "excellent" or "good" in all examinations (study group, 2.8; control group, 2.8). The algorithm automatically selected 100 kV in 47% and 80 kV in 34%; 120 kV was retained in 19%. An elevation to 140 kV did not occur. Compared with the control group, overall CT dose index volume reduction was 33.7%; overall dose-length product reduction was 31.5%. In the low-kilovolt scans, image noise and mean attenuation of ROIs inside the carotid arteries were significantly higher than in 120-kV scans, resulting in a constant or increased (80-kV group) contrast-to-noise ratio.The attenuation-based, kilovolt selection algorithm enables a dose reduction of >30% in carotid artery CTA while maintaining contrast-to-noise ratio and subjective image quality at adequate levels.
EVALuna2:14326

Cartilage loss in radiographically normal knees depends on radiographic status of the contralateral knee - data from the Osteoarthritis Initiative - Eckstein, F.; Maschek, S.; Roemer, Frank; Duda, G. N.; Sharma, L.; Wirth, Wolfgang (Osteoarthritis and Cartilage, 2019)
Objective: To test whether radiographically normal knees with contralateral radiographic knee osteoarthritis (OA), but without contralateral trauma history, display greater cartilage thickness loss than knees from subjects with bilaterally radiographically normal knees.
CRIS-Team WoS Importer:2019-02-21

CARTILAGE STRUCTURE AND KNEE FUNCTION IN SUBJECTS WITH AND WITHOUT PRESENCE OF MRI-DIAGNOSED CARTILAGE DAMAGE, AND WITHOUT RISK FACTORS OF KNEE OSTEOARTHRITIS - A 4-YEAR LONGITUDINAL STUDY USING DATA FROM THE OSTEOARTHRITIS INITIATIVE - Lapper, A.; Wisser, A.; Roemer, Frank; Maschek, S.; Wirth, W.; Duda, G.; Eckstein, F. (OSTEOARTHRITIS AND CARTILAGE, 2020)
CRIS-Team WoS Importer:2020-06-02

Cartilage thickness at the posterior medial femoral condyle is increased in femorotibial knee osteoarthritis: a cross-sectional CT arthrography study (Part 2) - Omoumi, P.; Michoux, N.; Roemer, Frank; Thienpont, E.; Vande Berg, B. C. (Osteoarthritis and Cartilage, 2015)
To evaluate the thickness of cartilage at the posterior aspect of the medial and lateral condyle in Osteoarthritis (OA) knees compared to non-OA knees using computed tomography arthrography (CTA).535 consecutive knee CTAs (mean patient age = 48.7 ± 16.0; 286 males), were retrospectively analyzed. Knees were radiographically classified into OA or non-OA knees according to a modified Kellgren/Lawrence (K/L) grading scheme. Cartilage thickness at the posterior aspect of the medial and lateral femoral condyles was measured on sagittal reformations, and compared between matched OA and non-OA knees in the whole sample population and in subgroups defined by gender and age.The cartilage of the posterior aspect of medial condyle was statistically significantly thicker in OA knees (2.43 mm (95% confidence interval (CI) = 2.36, 2.51)) compared to non-OA knees (2.13 mm (95%CI = 2.02, 2.17)) in the entire sample population (P < 0.001), as well as for all subgroups of patients over 40 years old (all P <= 0.01), except for females above 60 years old (P = 0.07). Increase in cartilage thickness at the posterior aspect of the medial condyle was associated with increasing K/L grade in the entire sample population, as well as for males and females separately (regression coefficient = 0.10-0.12, all P < 0.001). For the lateral condyle, there was no statistically significant association between cartilage thickness and OA (either presence of OA or K/L grade).Cartilage thickness at the non-weight-bearing posterior aspect of the medial condyle, but not of the lateral condyle, was increased in OA knees compared to non-OA knees. Furthermore, cartilage thickness at the posterior aspect of the medial condyle increased with increasing K/L grade.
EVALuna2:14578

Case report of severe constrictive perimyocarditis and ischemic hepatitis in a Crohn’s disease patient upon infliximab-induced lupus-like syndrome - Hirschmann, Simon; Fischer, Sarah; Klenske, Entcho; Dechant, Katharina; Distler, Jörg; Treutlein, Christoph; Neurath, Markus; Atreya, Raja (Therapeutic Advances in Gastroenterology, 2021)
Anti-tumor necrosis factor (TNF) antibodies have become an indispensable part in the therapeutic landscape of treating inflammatory bowel disease (IBD) patients. Nevertheless, they can be associated with the occurrence of severe systemic side effects. Here, we report the case of a 23-year-old patient with ileocolonic Crohn’s disease in endoscopic remission under ongoing anti-TNF infliximab therapy with occurrence of novel generalized arthralgia, pleuritic chest pain, and dyspnea. Clinical, laboratory, and imaging diagnostic workup in an extended clinical routine setting at the University Hospital of Erlangen, Germany, was used by a multidisciplinary team consisting of gastroenterologists, radiologists, cardiologists, and rheumatologists to investigate the underlying cause of the clinical symptoms in the patient. The results received using the aforementioned diagnostic setup led to the diagnosis of severe constrictive perimyocarditis due to infliximab-induced lupus-like syndrome with distinct ANA reactivity and elevated anti-dsDNA levels. Furthermore, pronounced ischemic hepatitis was diagnosed. Infliximab treatment was immediately stopped, and initiated corticosteroid pulse therapy only led to partial response as it had to be reduced due to pronounced psychiatric side effects. Persistent signs of pericarditis required additional ibuprofen therapy, which led to subsequent resolution of cardial symptoms. Formerly elevated liver enzymes returned to normal, and there were no clinical signs of recurrence of Crohn’s disease activity over 18 months of follow-up. The patient was subsequently switched to ustekinumab therapy for further treatment of underlying Crohn’s disease. This case report describes for the first time severe infliximab-induced lupus-like syndrome in an IBD patient, concurrently mimicking ST-elevation myocardial infarction with MRI visualization of pericarditis, occurrence of ischemic hepatitis, and pronounced signs of systemic inflammation.
CRIS-Team Scopus Importer:2021-10-15
Keywords: anti-TNF antibody; case report; Crohn’s disease; infliximab; lupus-like syndrome

Case report: upper arm metastasis of an oral squamous cell carcinoma - Wurm, Matthias; Nkenke, Emeka; Neukam, Friedrich Wilhelm; Moest, Tobias; Lutz, Rainer; Wehrhan, Falk; Brunner, Kathrin; Mitsimponas, Konstantinos; Schlechtweg, Philipp; von Wilmowsky, Cornelius (BMC Oral Health, 2015)
The Oral Squamous Cell Carcinoma (OSCC) frequently metastasizes lymphogenously. Haematogenous dissemination is less common. This report describes a rare case of a metastatic OSCC of the floor of the mouth to the patients' left upper arm. To our knowledge this is the first of such case described in the literature.Twelve months after R0 tumor resection surgery, including microvascular reconstruction of the lower jaw followed by adjuvant radiotherapy, the patient was admitted for osteosynthesis plates removal. During clinical examination a tumor located at his left upper arm was detected. According to the patient the tumor has demonstrated rapid growth. Macroscopic appearance and conventional imaging led to the differential diagnosis of an abscess. MR-imaging could not differentiate between a tumor of soft tissue origin and a metastasis. A biopsy was taken and the pathological examination confirmed the diagnosis of an OSCC metastasis. The postoperative interdisciplinary tumor board recommended radiation therapy.Due to the fact that patients with regional lymph node metastases have a higher probability to develop distant metastasis a more detailed screening might be considered - especially when hemangiosis carcinomatosa was histologically or macroscopically found.
EVALuna2:6693

Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report - Kamawal, A.; Schmidt, M. A.; Rompel, O.; Gusek-Schneider, G. C.; Mardin, C. Y.; Trollmann, Regina (Ophthalmologe, 2016)
Complications of acute bacterial sinusitis mostly occur in children and adolescents. In particular, intracranial spread of the infection can lead to severe even fatal courses of the disease. This article is a case report about a 13-year-old boy suffering from left-sided headache, meningismus and exophthalmos as presenting symptoms. Cranial magnetic resonance imaging (MRI) showed merely right-sided sphenoid sinusitis; however, the diffusion-weighted MRI sequence indicated a left-sided cavernous sinus thrombosis, which could be confirmed by computed tomography (CT) angiography. Cerebrospinal fluid diagnostics showed significant leukocytosis confirming secondary meningitis. Finally, exophthalmos was explained by parainfectious cavernous sinus thrombosis and periorbital edema. This case report highlights the importance of extended and specific diagnostic imaging in cases of clinically suspected complications in children and adolescents with sinusitis and the diagnostic significance of diffusion-weighted MRI.
EVALuna2:21321

CD133-Positive Membrane Particles in Cerebrospinal Fluid of Patients with Inflammatory and Degenerative Neurological Diseases - Bobinger, Tobias; May, Lisa-Sophie; Lücking, Hannes; Kloska, Stephan; Burkardt, Petra; Spitzer, Philipp; Maler, Juan M.; Corbeil, Denis; Huttner, Hagen (Frontiers in Cellular Neuroscience, 2017)
Background: Analysis of cerebrospinal fluid (CSF) is a frequently used diagnostic tool in a variety of neurological diseases. Recent studies suggested that investigating membrane particles enriched with the stem cell marker CD133 may offer new avenues for studying neurological disease. In this study, we evaluated the amount of membrane particle-associated CD133 in human CSF in neuroinflammatory and degenerative diseases. Methods: We compared the amount of membrane particle-associated CD133 in CSF samples collected from 45 patients with normal pressure hydrocephalus, parkinsonism, dementia, and cognitive impairment, chronic inflammatory diseases and 10 healthy adult individuals as controls. After ultracentrifugation of CSF, gel electrophoresis and immunoblotting using anti-CD133 monoclonal antibody 80B258 were performed. Antigen-antibody complexes were detected using chemiluminescence. Results: The amount of membrane particle-associated CD133 was significantly increased in patients with normal pressure hydrocephalus (p < 0.001), parkinsonism (p = 0.011) as well as in patients with chronic inflammatory disease (p = 0.008). Analysis of CSF of patients with dementia and cognitive impairment revealed no significant change compared with healthy individuals. Furthermore, subgroup analysis of patients with chronic inflammatory diseases demonstrated significantly elevated levels in individuals with relapsing-remitting multiple sclerosis (p = 0.023) and secondary progressive multiple sclerosis (SPMS; p = 0.010). Conclusion: Collectively, our study revealed elevated levels of membrane particle-associated CD133 in patients with normal pressure hydrocephalus, parkinsonism as well as relapsing-remitting and SPMS. Membrane glycoprotein CD133 may be of clinical value for several neurological diseases.
EVALuna2:22515

CD19-targeted CAR T cells in refractory antisynthetase syndrome - Müller, Fabian; Böltz, Sebastian; Knitza, Johannes; Aigner, Michael; Völkl, Simon; Kharboutli, Soraya; Reimann, Hannah; Taubmann, Jule; Kretschmann, Sascha; Rösler, Wolf; Manger, Bernhard; Wacker, Jochen; et al. (Lancet, 2023)
CRIS-Team Scopus Importer:2023-03-24

Central nervous system anomalies in two females with Borjeson-Forssman-Lehmann syndrome - Kasper, Burkhard; Dörfler, Arnd; Di Donato, Nataliya; Kasper, Ekkehard M.; Wieczorek, Dagmar; Hoyer, Juliane; Zweier, Christiane (Epilepsy and Behavior, 2017)
Borjeson-Forssman-Lehmann syndrome (BFLS) is a rare disorder caused by mutations in the PHF6 gene. It manifests as syndromic X-linked recessive intellectual disability (ID) in males and as sporadic ID due to de novo mutations in females. Clinical features include variable ID and a range of somatic manifestations constituting a distinct phenotype in both males and females, respectively, including seizures in a few. Central nervous system (CNS) imaging data are largely unavailable for BFLS. Here we report on CNS MRI findings from two female individuals with BFLS due to a de novo duplication in PHF6 who presented with typical BFLS and epilepsy. Brain findings encompass an intriguing combination of structural abnormalities including a simplified gyral pattern and aspects resembling subcortical band heterotopia as signs of malformation of cortical development (MCD). This finding is of note, since PHF6 has been suggested to play pivotal roles in CNS development including neuronal migration.
EVALuna2:9368

CENTRAL NERVOUS SYSTEM PAIN RESPONSE AND COMPONENTS OF DISEASE ACTIVITY IN RA PATIENTS AFTER TREATMENT WITH CERTOLIZUMAB OR PLACEBO: A POST-HOC ANALYSIS FROM THE PRECEPRA TRIAL - Schenker, Hannah; Rech, Jürgen; Tascilar, K.; Hagen, Melanie; Schoenau, V.; Sergeeva, Marina; Selvakumar, Mageshwar; Konerth, Laura; Prade, Jutta; Strobelt, Sandra; Valor, L.; Hueber, A.; et al. (ANNALS OF THE RHEUMATIC DISEASES, 2020)
CRIS-Team WoS Importer:2020-08-21

Central pulse pressure predicts BP reduction after renal denervation in patients with treatment-resistant hypertension - Ott, Christian; Schmid, Axel; Toennes, Stefan W.; Ditting, Tilmann; Veelken, Roland; Uder, Michael; Schmieder, Roland (EuroIntervention, 2015)
Enhanced vascular ageing is associated with elevated central pulse pressure (cPP), an independent predictor of cardiovascular (CV) events. Although antihypertensive treatment strategies are effective, high residual CV risk remains indicative of advanced and largely irreversible vascular damage. Renal denervation (RDN) has been shown to reduce blood pressure (BP) to various extents in patients with treatment-resistant hypertension (TRH). We hypothesised that cPP predicts BP reduction after RDN.Sixty-three patients with true TRH underwent catheter-based RDN using the Symplicity Flex(TM) catheter and were followed for six months. At baseline, cPP was assessed by pulse wave analysis (SphygmoCor(TM)). Patients were stratified according to their median cPP (55 mmHg), and called "low cPP" (below the median) or "high cPP" (above the median). Office BP reduction six months after RDN was greater (-22±19/-13±11 vs. -12±20/-5±13 mmHg, p=0.038/0.014) and 24-hr ambulatory blood pressure (ABP) reduction tended to be greater (-11±13/-8±10 vs. -3±18/-4±10 mmHg, p=0.070/0.112) in patients with low cPP compared to those with high cPP. Only cPP (?=0.687, p=0.001) and baseline systolic BP (?=-0.564, p<0.001) were independent determinants of office systolic BP reduction after RDN.Our data suggest that cPP, indicative of the degree of large arterial stiffening, may be helpful to identify responders to RDN.
EVALuna2:3764

Cerebral aneurysm treatment using flow-diverting stents: in-vivo visualization of flow alterations by parametric colour coding to predict aneurysmal occlusion: preliminary results - Gölitz, Philipp; Struffert, Tobias; Roesch, Julie; Ganslandt, Oliver Thomas; Knossalla, Frauke; Dörfler, Arnd (European Radiology, 2015)
After deployment of flow-diverting stents (FDS), complete aneurysm occlusion is not predictable. This study investigated whether parametric colour coding (PCC) could allow in vivo visualization of flow alterations induced by FDS and identify favourable or adverse flow modulations.Thirty-six patients treated by FDS were analyzed. Preinterventional and postinterventional DSA-series were postprocessed by PCC and time-density curves (TDCs) were calculated. The parameters aneurysmal inflow, outflow, and relative time-to-peak (rTTP) were calculated. Preinterventional and postinterventional values were compared and related to occlusion rate.Postinterventional inflow showed a mean reduction of 37%, outflow of 51%, and rTTP a prolongation of 82%. Saccular aneurysm occlusion occurred if a reduction of at least 15% was achieved for inflow and 35% for outflow (sensitivity: 89%, specificity: 82%). Unchanged outflow and a slightly prolonged rTTP were associated with growth in one fusiform aneurysm.PCC allows visualization of flow alterations after FDS treatment, illustrating "flow diverting effects" by the TDC shape and indicating mainly aneurysmal outflow and lesser inflow changes. Quantifiable parameters (inflow, outflow, rTTP) can be obtained, thresholds for predicting aneurysm occlusion determined, and adverse flow modulations assumed. As a rapid intraprocedural tool, PCC might support the decision to implant more than one FDS.o After deployment of a flow-diverting stent, complete aneurysm occlusion is unpredictable. o Parametric colour coding offers new options for visualizing in vivo flow alterations non-invasively. o Quantifiable parameters, i.e., aneurysmal inflow/outflow can be obtained allowing prognostic stratification. o Rapid, intraprocedural application allows treatment monitoring, potentially contributing to patient safety.
EVALuna2:22356

Cerebral Ischemia in Patients on Direct Oral Anticoagulants - Macha, Kosmas; Marsch, Armin; Siedler, Gabriela; Breuer, Lorenz; Strasser, Erwin; Engelhorn, Tobias; Schwab, Stefan; Kallmünzer, Bernd (Stroke, 2019)
Background and Purpose- In patients with ischemic stroke on therapy with vitamin K antagonists, stroke severity and clinical course are affected by the quality of anticoagulation at the time of stroke onset, but clinical data for patients using direct oral anticoagulants (DOACs) are limited. Methods- Data from our registry including all patients admitted with acute cerebral ischemia while taking oral anticoagulants for atrial fibrillation between November 2014 and October 2017 were investigated. The activity of vitamin K antagonists was assessed using the international normalized ratio on admission and categorized according to a threshold of 1.7. DOAC plasma levels were measured using the calibrated Xa-activity (apixaban, rivaroxaban, and edoxaban) or the Hemoclot-assay (dabigatran) and categorized into low (<50 ng/mL), intermediate (50-100 ng/mL), or high (>100 ng/mL). Primary objective was the association between anticoagulant activity and clinical and imaging characteristics. Results- Four hundred sixty patients were included (49% on vitamin K antagonists and 51% on DOAC). Patients on vitamin K antagonists with low international normalized ratio values had higher scores on the National Institutes of Health Stroke Scale and a higher risk of large vessel occlusion on admission. For patients on DOAC, plasma levels were available in 75.6% and found to be low in 49 (27.7%), intermediate in 41 (23.2%), and high in 87 patients (49.2%). Low plasma levels were associated with higher National Institutes of Health Stroke Scale scores on admission (low: 8 [interquartile range, 3-15] versus intermediate: 4 [1-11] versus high: 3 [0-8]; P<0.001) and higher risk of persisting neurological deficits or cerebral infarction on imaging (85.7% versus 75.6% versus 54.0%; P<0.001). Low DOAC plasma levels were an independent predictor of large vessel occlusion (odds ratio, 3.84 [95% CI, 1.80-8.20]; P=0.001). Conclusions- The activity of anticoagulation measured by specific DOAC plasma levels on admission is associated with stroke severity and presence of large vessel occlusion.
CRIS-Team Scopus Importer:2019-07-19
Keywords: anticoagulants; atrial fibrillation; direct oral anticoagulants; ischemic stroke; plasma level

Cerebral lesion correlates of sympathetic cardiovascular activation in multiple sclerosis - Winder, Klemens; Linker, Ralf A.; Seifert, Frank; Wang, Ruihao; Lee, De Hyung; Engelhorn, Tobias; Dörfler, Arnd; Fröhlich, Katharina; Hilz, Max-Josef (Human Brain Mapping, 2019)
Cardiovascular autonomic dysfunction is common in multiple sclerosis (MS) and contributes significantly to disability. We hypothesized that cerebral MS-lesions in specific areas of the central autonomic network might account for imbalance of the sympathetic and parasympathetic cardiovascular modulation. Therefore, we used voxel-based lesion symptom mapping (VLSM) to determine associations between cardiovascular autonomic dysfunction and cerebral MS-related lesion sites. In 74 MS-patients (mean age 37.0 ± 10.5 years), we recorded electrocardiographic RR-intervals and systolic and diastolic blood pressure. Using trigonometric regressive spectral analysis, we assessed low (0.04–0.15 Hz) and high (0.15–0.5 Hz) frequency RR-interval-and blood pressure-oscillations and determined parasympathetically mediated RR-interval–high-frequency modulation, mainly sympathetically mediated RR-interval–low-frequency modulation, sympathetically mediated blood pressure-low-frequency modulation, and the ratios of sympathetic and parasympathetic RR-interval-modulation as an index of sympathetic-parasympathetic balance. Cerebral MS-lesions were analyzed on imaging scans. We performed a VLSM-analysis correlating parameters of autonomic dysfunction with cerebral MS-lesion sites. The VLSM-analysis showed associations between increased RR-interval low-frequency/high-frequency ratios and lesions most prominently in the left insular, hippocampal, and right frontal inferior opercular region, and a smaller lesion cluster in the right middle cerebellar peduncle. Increased blood pressure-low-frequency powers were associated with lesions primarily in the right posterior parietal white matter and again left insular region. Our data indicate associations between a shift of cardiovascular sympathetic-parasympathetic balance toward increased sympathetic modulation and left insular and hippocampal lesions, areas of the central autonomic network. The VLSM-analysis further distinguished between right inferior fronto-opercular lesions disinhibiting cardiac sympathetic activation and right posterior parietal lesions increasing sympathetic blood pressure modulation.
CRIS-Team Scopus Importer:2019-08-23
Keywords: autonomic dysfunction; insular lesion; multiple sclerosis; visceral arousal; voxel-based lesion symptom mapping

Cerebral lesions sites in neurosarcoidosis: a lesion mapping study - Fröhlich, Kilian; Mrochen, Anne; Wang, Ruihao; Haupenthal, David; Macha, Kosmas; Siedler, Gabriela; Knott, Michael; Dörfler, Arnd; Schwab, Stefan; Winder, Klemens (Journal of Neurology, 2023)
Background and purpose: Sarcoidosis is a granulomatous disease of unknown etiology affecting the central nervous system in up to 15% of the patients. Diagnosis of neurosarcoidosis is very challenging due to the heterogeneity of its clinical manifestation. This study intended to evaluate the distribution of cerebral lesion sites and the potential presence of specific lesion clusters in neurosarcoidosis patients using voxel-based lesion symptom mapping (VLSM). Methods: Patients with neurosarcoidosis were retrospectively identified and included between 2011 and 2022. Cerebral lesion sites were correlated voxel-wise with presence and absence of neurosarcoidosis using non-parametric permutation test. Multiple sclerosis patients served as controls for the VLSM-analysis. Results: Thirty-four patients (mean age 52 ± 15 years) of whom 13 were diagnosed with possible, 19 with probable and 2 with confirmed neurosarcoidosis were identified. Lesion overlap of neurosarcoidosis patients demonstrated a distribution of white matter lesions in all brain areas, with a periventricular predilection similar to multiple sclerosis. In contrast to multiple sclerosis controls, no propensity for lesions in proximity of the corpus callosum was observed. Neurosarcoidosis lesions appeared smaller and lesion volume was lower in the neurosarcoidosis cohort. The VLSM analysis showed minor associations between neurosarcoidosis and damaged voxels in the bilateral frontobasal cortex. Conclusions: The VLSM analysis yielded significant associations in the bilateral frontal cortex, suggesting that leptomeningeal inflammatory disease with following cortical involvement is a quite specific feature in neurosarcoidosis. Lesion load was lower in neurosarcoidosis than in multiple sclerosis. However, no specific pattern of subcortical white matter lesions in neurosarcoidosis was revealed.
CRIS-Team Scopus Importer:2023-07-21
Keywords: Cerebral lesions; Neurosarcoidosis; Sarcoidosis; Voxel-based lesion symptom mapping

Cerebral lipogranuloma: A penetrating traumatic brain injury - Hagen, Manuel; Coras, Roland; Engelhorn, Tobias; Schwab, Stefan; Seifert, Frank (Neurology, 2020)
CRIS-Team Scopus Importer:2020-12-11

Cerebral Microinfarcts in Primary Open-Angle Glaucoma Correlated With DTI-Derived Integrity of Optic Radiation - Schoemann, Johannes; Engelhorn, Tobias; Wärntges, Simone; Dörfler, Arnd; El-Rafei, Ahmed Mohamed Ibrahim; Michelson, Georg (Investigative Ophthalmology & Visual Science, 2014)
To evaluate the correlation between the extent of cerebral white matter lesions (WMLs) and the integrity of the visual pathway represented by fractional anisotropy (FA) in patients with primary open-angle glaucoma (POAG).This case-control study included a total of 61 German patients (39 POAG patients, 22 controls) matched for age and sex. Fractional anisotropy of the optic radiation was determined by 3-Tesla diffusion tensor imaging. White matter lesions and brain volumes were manually measured by using a T2-weighted, 3-D fluid-attenuated inversion recovery sequence.In POAG patients WML volumes were significantly (P = 0.04) increased in the subcortical area. This applied for both absolute and relative units to the specific patient's brain volume, compared to controls. The WML volumes were significantly (P = 0.003) greater in middle-aged (40-59 years) POAG patients than control patients. In controls there was a significant age correlation of WML volumes in the total brain, subcortical, and optic radiation regions of interest. There was a significant correlation between FA and WML in POAG regarding the total brain, the periventricular region, and the optic radiation in both hemispheres. In POAG, FA left and right optic radiation correlated significantly with age (P = 0.002).We were able to demonstrate that (1) POAG patients aged 40 to 60 years had higher volumes of cerebral microinfarcts and (2) POAG patients showed a significant correlation between cerebral microinfarcts and degeneration of the optic radiation. This indicates that cerebral microinfarcts might be an intracerebral risk factor for glaucomatous optic nerve atrophy.
EVALuna2:21212

Cerebral Networks Linked to Itch-related Sensations Induced by Histamine and Capsaicin - Vierow, Verena; Forster, Clemens; Vogelgsang, Rebekka; Dörfler, Arnd; Handwerker, Hermann Otto (Acta Dermato-Venereologica, 2015)
This functional magnetic resonance imaging (fMRI) study explored the central nervous processing of itch induced by histamine and capsaicin, delivered via inactivated cowhage spicules, and the influence of low-dose naltrexone. Scratch bouts were delivered at regular intervals after spicule insertion in order temporarily to suppress the itch. At the end of each trial the subjects rated their itch and scratch-related sensations. Stepwise multiple regression analyses were employed for identifying cerebral networks contributing to the intensities of "itching", "burning", "stinging", "pricking" and "itch relief by scratching". In the capsaicin experiments a network for "burning" was identified, which included the posterior insula, caudate and putamen. In the histamine experiments networks for "itching" and "itch relief" were found, which included operculum, hippocampus and amygdala. Naltrexone generally reduced fMRI activation and the correlations between fMRI signal and ratings. Furthermore, scratching was significantly less pleasant under naltrexone.
EVALuna2:2447

CEREBROSPINAL FLUID BIOMARKERS FOR CEREBRAL AMYLOID ANGIOPATHY - Sembill, Jochen; Lusse, C.; Linnerbauer, Mathias; Sprügel, Maximilian; Mrochen, Anne; Knott, Michael; Hölter, Philip; Engelhorn, Tobias; Schmidt, M.; Dörfler, Arnd; Oberstein, Timo; Maler, Juan Manuel; et al. (INTERNATIONAL JOURNAL OF STROKE, 2022)
CRIS-Team WoS Importer:2022-11-18

Cerebrospinal fluid biomarkers for cerebral amyloid angiopathy - Sembill, Jochen; Lusse, Christoph; Linnerbauer, Mathias; Sprügel, Maximilian; Mrochen, Anne; Knott, Michael; Engelhorn, Tobias; Schmidt, Manuel; Dörfler, Arnd; Oberstein, Timo; Maler, Juan Manuel; Kornhuber, Johannes; et al. (Brain Communications, 2023)
Integrating cerebrospinal fluid-biomarkers into diagnostic workup of patients with sporadic cerebral amyloid angiopathy may support early and correct identification. We aimed to identify and validate clinical- and cerebrospinal fluid-biomarkers for in vivo diagnosis of cerebral amyloid angiopathy. This observational cohort study screened 2795 consecutive patients admitted for cognitive complaints to the academic departments of neurology and psychiatry over a 10-year period (2009–2018). We included 372 patients with available hemosiderin-sensitive MR imaging and cerebrospinal fluid-based neurochemical dementia diagnostics, i.e. Aβ40, Aβ42, t-tau, p-tau. We investigated the association of clinical- and cerebrospinal fluid-biomarkers with the MRI-based diagnosis of cerebral amyloid angiopathy, applying confounder-adjusted modelling, receiver operating characteristic and unsupervised cluster analyses. We identified 67 patients with cerebral amyloid angiopathy, 76 patients with Alzheimer’s disease, 75 patients with mild cognitive impairment due to Alzheimer’s disease, 76 patients with mild cognitive impairment with unlikely Alzheimer’s disease and 78 healthy controls. Patients with cerebral amyloid angiopathy showed a specific cerebrospinal fluid pattern: average concentration of Aß40 [13 792 pg/ml (10 081–18 063)] was decreased compared to all controls (P < 0.05); Aß42 [634 pg/ml (492–834)] was comparable to Alzheimer’s disease and mild cognitive impairment due to Alzheimer’s disease (P = 0.10, P = 0.93) but decreased compared to mild cognitive impairment and healthy controls (both P < 0.001); p-tau [67.3 pg/ml (42.9–91.9)] and t-tau [468 pg/ml (275–698)] were decreased compared to Alzheimer’s disease (P < 0.001, P = 0.001) and mild cognitive impairment due to Alzheimer’s disease (P = 0.001, P = 0.07), but elevated compared to mild cognitive impairment and healthy controls (both P < 0.001). Multivariate modelling validated independent clinical association of cerebral amyloid angiopathy with older age [odds-ratio: 1.06, 95% confidence interval (1.02–1.10), P < 0.01], prior lobar intracerebral haemorrhage [14.00 (2.64–74.19), P < 0.01], prior ischaemic stroke [3.36 (1.58–7.11), P < 0.01], transient focal neurologic episodes (TFNEs) [4.19 (1.06–16.64), P = 0.04] and gait disturbance [2.82 (1.11–7.15), P = 0.03]. For cerebrospinal fluid-biomarkers per 1 pg/ml, both lower Aß40 [0.9999 (0.9998–1.0000), P < 0.01] and lower Aß42 levels [0.9989 (0.9980–0.9998), P = 0.01] provided an independent association with cerebral amyloid angiopathy controlled for all aforementioned clinical confounders. Both amyloid biomarkers showed good discrimination for diagnosis of cerebral amyloid angiopathy among adjusted receiver operating characteristic analyses (area under the receiver operating characteristic curves, Aß40: 0.80 (0.73–0.86), P < 0.001; Aß42: 0.81 (0.75–0.88), P < 0.001). Unsupervised Euclidian clustering of all cerebrospinal fluid-biomarker-profiles resulted in distinct segregation of cerebral amyloid angiopathy patients from all controls. Together, we demonstrate that a distinctive set of cerebrospinal fluid-biomarkers effectively differentiate cerebral amyloid angiopathy patients from patients with Alzheimer’s disease, mild cognitive impairment with or without underlying Alzheimer’s disease, and healthy controls. Integrating our findings into a multiparametric approach may facilitate diagnosing cerebral amyloid angiopathy, and may aid clinical decision-making, but warrants future prospective validation.
CRIS-Team Scopus Importer:2023-07-21
Keywords: biomarker; cerebral amyloid angiopathy; cerebrospinal fluid; dementia; small vessel disease

Cerebrovascular complications of immunologically mediated heparin-induced thrombocytopenia - Macha, K.; Kloska, Stephan; Dörfler, Arnd; Raaz-Schrauder, D.; Schwab, Sibylle; Köhrmann, Martin; Seifert, Frank (Fortschritte der Neurologie - Psychiatrie, 2014)
Immunologically mediated heparin-induced thrombocytopenia (HIT) is a thrombotic disease caused by antibodies occurring after heparin exposure. Thrombocytopenia occurs within a few days after heparin exposure, about half of HIT-patients develop venous or arterial thrombotic complications. Neurological complications of HIT are mainly ischaemic stroke and sinus vein thrombosis. To ensure the primary clinical diagnosis functional and immunological assays for antibody detection are available. The probability for the occurrence of HIT depends on the nature of heparin employed (LMWH vs. UFH) and individual patient characteristics such as gender and primary disease (medical vs. surgical patients). In the case of suspected HIT heparin administration should be discontinued immediately and replaced by an alternative anticoagulation to prevent the expansion or development of further thrombotic complications. Herein we report a case of a patient suffering from HIT-associated embolic cerebral ischaemic stroke.
EVALuna2:22326

Change in the radio-oncological Treatment Concept for Brain Metastases through a dedicated Radiotherapy Planning MRI - Voigt, R.; Masitho, Siti; Grigo, Johanna; Reissig, L.; Uder, Michael; Semrau, Sabine; Fietkau, Rainer; Bert, Christoph; Putz, Florian (STRAHLENTHERAPIE UND ONKOLOGIE, 2022)
CRIS-Team WoS Importer:2022-06-03

Changes in patellofemoral and tibiofemoral joint cartilage damage and bone marrow lesions over 7 years: the Multicenter Osteoarthritis Study - Stefanik, J. J.; Guermazi, A.; Roemer, Frank; Peat, G.; Niu, J.; Segal, N. A.; Lewis, C. E.; Nevitt, M.; Felson, D. T. (Osteoarthritis and Cartilage, 2016)
To investigate changes in cartilage damage and bone marrow lesions (BMLs) on MRI in the patellofemoral and tibiofemoral joints (TFJs) over 7 years.The Multicenter Osteoarthritis (MOST) Study is a cohort study of persons aged 50-79 years at baseline with or at high risk for knee osteoarthritis (OA). Knees were eligible for the current study if they had knee MRI (1.0T) assessed for cartilage damage and BMLs at the baseline and 84-month visits. Knees were categorized as having MRI-detected structural damage (cartilage and BMLs) isolated to the patellofemoral joint (PFJ), isolated to the TFJ, mixed or no damage at baseline and 84-months. We determined the changes in PFJ and TFJ structural damage over 7 years and used logistic regression to assess the relation of baseline compartment distribution to incident isolated PFJ, isolated TFJ and mixed damage.Among 339 knees that had full-thickness cartilage loss isolated to the PFJ or TFJ at baseline, only 68 (20.1%) developed full-thickness cartilage loss in the other compartment while 271 (79.9%) continued to only have the initial compartment affected. Compared to knees without full-thickness cartilage damage (n = 582), those with isolated TFJ and PFJ full-thickness cartilage damage had 2.7 (1.5, 4.9) and 5.8 (3.6, 9.6) times the odds of incident mixed full-thickness cartilage damage, respectively. Similar results were seen when using other definitions of MRI-defined structural damage.Most knees with structural damage at baseline do not develop it in the other compartment. Knees that develop mixed structural damage are more likely to start with it isolated to the PFJ.
EVALuna2:14691

Changes in T2 Relaxation Time Mapping of Intervertebral Discs Adjacent to Vertebrae after Kyphoplasty Correlate with the Physical Clinical Outcome of Patients - Wegener, Lisa; Werner, Felix; Kleyer, Arnd; Simon, David; Uder, Michael; Janka, Rolf Matthias; Trattnig, Siegfried; Welsch, Goetz H.; Pachowsky, Milena (Diagnostics, 2022)
(1) Background: To assess whether clinical outcomes correlate with tissue changes in the intervertebral discs (IVDs) after kyphoplasty as treatment for vertebral fractures, quantitative MRI was applied. (2) Methods: Quantitative T2 mapping acquired in a 3 T MRI scanner of the thoracolumbar spine was performed in 20 patients two years after kyphoplasty. The IVDs adjacent and nonadjacent to the treated vertebrae were divided into six regions of interest (ROI), which were further categorised into inner (ROI 2–5) and outer (ROI 1 and 6) parts of the IVDs, and the T2 values were analysed. T2 values of adjacent discs were correlated with the items of questionnaires evaluating the clinical outcome (i.e., 36-Item Short Form Survey). (3) Results: Lower T2 values in adjacent IVDs correlated with poorer physical outcome two years after kyphoplasty. The inner part of the IVDs adjacent to treated vertebrae showed statistically significant lower T2 values in segments L2/L3 and L3/L4 compared to nonadjacent ones. Patients with lower T2 values showed more pain and physical limitations in everyday life. (4) Conclusions: Quantitative T2 mapping can detect IVD degeneration in patients after kyphoplasty and correlates with the physical outcome. This technique could help to gain better insights into alterations in tissue composition following kyphoplasty and the consequences for the patients’ quality of life.
CRIS-Team Scopus Importer:2022-03-11
Keywords: Clinical outcome; Intervertebral disc; Kyphoplasty; MRI; T2 mapping

Changes in tissue sodium concentration and sodium relaxation times during the maturation of human knee cartilage: Ex vivo 23Na MRI study at 10.5 T - Zbýň, Štefan; Ludwig, Kai D.; Watkins, Lauren E.; Lagore, Russell L.; Nowacki, Amanda; Tóth, Ferenc; Tompkins, Marc A.; Zhang, Lin; Adriany, Gregor; Gold, Garry E.; Shea, Kevin G.; Nagel, Armin Michael; et al. (Magnetic Resonance in Medicine, 2023)
Purpose: To evaluate the influence of skeletal maturation on sodium (23Na) MRI relaxation parameters and the accuracy of tissue sodium concentration (TSC) quantification in human knee cartilage. Methods: Twelve pediatric knee specimens were imaged with whole-body 10.5 T MRI using a density-adapted 3D radial projection sequence to evaluate 23Na parameters: B1+, T1, biexponential (Formula presented.), and TSC. Water, collagen, and sulfated glycosaminoglycan (sGAG) content were calculated from osteochondral biopsies. The TSC was corrected for B1+, relaxation, and water content. The literature-based TSC (TSCLB) used previously published values for corrections, whereas the specimen-specific TSC (TSCSP) used measurements from individual specimens. 23Na parameters were evaluated in eight cartilage compartments segmented on proton images. Associations between 23Na parameters, TSCLB − TSCSP difference, biochemical content, and age were determined. Results: From birth to 12 years, cartilage water content decreased by 18%; collagen increased by 59%; and sGAG decreased by 36% (all R2 ≥ 0.557). The short (Formula presented.) ((Formula presented.)) decreased by 72%, and the signal fraction relaxing with (Formula presented.) ((Formula presented.)) increased by 55% during the first 5 years but remained relatively stable after that. TSCSP was significantly correlated with sGAG content from biopsies (R2 = 0.739). Depending on age, TSCLB showed higher or lower values than TSCSP. The TSCLB − TSCSP difference was significantly correlated with (Formula presented.) (R2 = 0.850), (Formula presented.) (R2 = 0.651), and water content (R2 = 0.738). Conclusion: TSC and relaxation parameters measured with 23Na MRI provide noninvasive information about changes in sGAG content and collagen matrix during cartilage maturation. Cartilage TSC quantification assuming fixed relaxation may be feasible in children older than 5 years.
CRIS-Team Scopus Importer:2023-12-01
Keywords: 10.5 T; biochemical composition of cartilage; knee cartilage maturation; sodium (; tissue sodium concentration

Change your Angle of View Sinusoidal C-Arm Movement in Cranial Flat-panel CT to Improve Image Quality - Lücking, Hannes; Hölter, Philip; Lang, Stefan; Schmidt, Manuel; Eisenhut, Felix; Dörfler, Arnd (Clinical Neuroradiology, 2022)
Background Artifacts from surrounding bony structures, especially from the petrous bones, regularly impair soft tissue computed tomography (CT) imaging of the middle and posterior fossa. This affects flat-panel CT in particular. Sinusoidal movement of the C-arm during acquisition (i.e. craniocaudal tilting along with semicircular rotation) is supposed to reduce artifacts, thus enhancing soft tissue imaging quality. Methods In the work-up of ischemic stroke or subarachnoid hemorrhage 40 patients underwent multi-slice CT (MS-CT) and either plain circular (cFP-CT; n = 20) or sinusoidal (sFP-CT; n = 20) flat-panel CT within a short interval. Two independent readers analyzed MS-CT and FP-CT datasets for recognizability of eight different brain structures and three typical types of artifacts according to a predetermined score. Results Interrater reliability was moderate for cFP-CT (kappa = 0.575) and good to very good for ratings of MS-CT and sFP-CT (kappa = 0.651 to kappa = 1). MS-CT was rated to be significantly better than cFP-CT and sFP-CT (p < 0.0001) in the overall score. Yet, sFP-CT was rated to be significantly superior to cFP-CT (overall p < 0.0001) regarding most anatomical regions and petrous bone artifacts. Conclusion Compared to a standard circular protocol, sinusoidal C-arm movement in cranial FP-CT can significantly reduce artifacts in the posterior fossa and, moreover, can improve visualization of most supratentorial and infratentorial anatomical structures.
CRIS-Team WoS Importer:2022-05-20

Chapter 5: Separating Flow from Diffusion Using Velocity-compensated Diffusion Encoding - Wetscherek, Andreas; Laun, Frederik Bernd (New Developments in NMR, 2020)
The two major transport processes occurring in the human body are diffusion and flow. When a rephased gradient-time profile is applied, both processes leave their fingerprint in the magnetic resonance signal. Plug flow along a single direction results in an additional signal phase, but stationary and non-stationary random flow leave the same fingerprint as diffusion-a signal attenuation. A classic approach to separate diffusion and non-plug flow is to use the difference in transport distance. It differs by more than an order of magnitude for typical time scales in MRI experiments and entails a much faster signal decay for the flow compartment than for the diffusion compartment. Besides the classical approach, further strategies have been proposed to reveal the nature of the flow processes in more depth by adding additional measurement dimensions to the experiment. These dimensions include inversion time, echo time, and field strength to alter the signal contributions, but duration and shape of the gradient-time profile were also employed to change the degree of flow-weighting and to probe flow correlation times. It was found that flow-compensated gradients strongly suppress the flow-related signal decay in vivo, indicating that a ballistic description is more appropriate than assuming a diffusion-like flow.
CRIS-Team Scopus Importer:2021-04-19

Chapter 6: Epidemiology S3-leitlinie extracranielle carotisstenose: kapitel 6: epidemiologie - Sander, D.; Diehm, C.; Eckstein, H. -H.; Kuehnl, A.; Berkefeld, J.; Diel, R.; Dörfler, Arnd; Kopp, I.; Langhoff, R.; Lawall, H.; Ringleb, P.; Storck, Martin (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Chapter 7: Symptoms and diagnosis of carotid stenosis S3-leitlinie extracranielle carotisstenose: kapitel 7: symptome und diagnostik von carotisstenosen - Ringleb, P.; Goertler, M.; Nabavi, D. G.; Arning, C.; Sander, D.; Eckstein, H. -H.; Kuehnl, A.; Berkefeld, J.; Diel, R.; Dörfler, Arnd; Kopp, I.; Langhoff, R.; et al. (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Chapter 8.13: Which materials (catheters, stents, protection systems) are to be preferred in CAS? S3-Leitlinie Extracranielle Carotisstenose: Kapitel 8.13: Welche Materialien (Katheter, Stents, Protektionssysteme) sind bei CAS zu bevorzugen? - Berkefeld, J.; Dörfler, Arnd (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Chapter 8.14: What is to be taken into account for an optimal peri-interventional management? S3-Leitlinie Extracranielle Carotisstenose: Kapitel 8.14: Was ist zu beachten für ein optimales periinterventionelles Management? - Berkefeld, J.; Dörfler, Arnd (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Chapter 8.15: How does the optimal management of peri-interventional complications look like? S3-Leitlinie Extracranielle Carotisstenose: Kapitel 8.15: Wie sieht das optimale Management periinterventioneller Komplikationen aus? - Berkefeld, J.; Dörfler, Arnd (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Chapter 8.19: Which requirements on further education and structural quality are to be imposed on institutions in which angiographies or operative/endovascular revascularizations of the carotid artery are conducted? S3-Leitlinie Extracranielle Carotisstenose: Kapitel 8.19: Welche Anforderungen an Weiterbildung und Strukturqualität ist an Einrichtungen zu stellen, in denen Angiographien oder operative/endovaskuläre Revaskularisationen der A. Carotis durchgeführt werden? - Storck, Martin; Berkefeld, J.; Dörfler, Arnd (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Chapter 8.20: Is there a connection among qualification, volume (individual, hospital) and outcome for the operative or endovascular treatment? S3-Leitlinie Extracranielle Carotisstenose: Kapitel 8.20: Gibt es einen Zusammenhang zwischen Qualifikation, Volume (individuell, Klinik) und Outcome für die operative oder endovaskuläre Therapie - Eckstein, H. -H.; Berkefeld, J.; Dörfler, Arnd (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Chapter 8.5: Is PTA alone compared with PTA with stent associated with varyingly high rates of success, complications and relapses in patients with high-grade extracranial carotid stenosis? S3-leitlinie extracranielle carotisstenose: Kapitel 8.5: Ist bei patienten mit einer hochgradigen extracraniellen carotisstenose die alleinige PTA im vergleich zur PTA mit stent mit unterschiedlich hohen erfolgs-, komplikations- und rezidivraten assoziiert? - Berkefeld, J.; Dörfler, Arnd (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Chapter 9: Aftercare, relapse treatment and quality of life S3-Leitlinie Extracranielle Carotisstenose: Kapitel 9: Nachsorge, Rezidivtherapie und Lebensqualität - Lawall, H.; Goertler, M.; Ringleb, P.; Sander, D.; Eckstein, H. -H.; Kuehnl, A.; Berkefeld, J.; Diel, R.; Dörfler, Arnd; Kopp, I.; Langhoff, R.; Storck, Martin (Gefässchirurgie, 2012)
CRIS-Team Scopus Importer:2022-08-05

Characteristics in Non-Vitamin K Antagonist Oral Anticoagulant-Related Intracerebral Hemorrhage - Gerner, Stefan; Kuramatsu, Joji; Sembill, Jochen; Sprügel, Maximilian; Hagen, Manuel; Knappe, Ruben U.; Endres, Matthias; Haeusler, Karl Georg; Sobesky, Jan; Schurig, Johannes; Zweynert, Sarah; Bauer, Miriam; et al. (Stroke, 2019)
Background and Purpose Given inconclusive studies, it is debated whether clinical and imaging characteristics, as well as functional outcome, differ among patients with intracerebral hemorrhage (ICH) related to vitamin K antagonists (VKA) versus non-vitamin K antagonist (NOAC)-related ICH. Notably, clinical characteristics according to different NOAC agents and dosages are not established.
CRIS-Team WoS Importer:2019-06-18

Characteristics of acute groin injuries in the hip flexor muscles - a detailed MRI study in athletes - Serner, Andreas; Weir, A.; Tol, J. L.; Thorborg, K.; Roemer, Frank; Guermazi, A.; Yamashiro, E.; Holmich, P. (Scandinavian journal of medicine & science in sports, 2018)
Hip flexor injuries account for one-third of acute groin injuries; however, little is known about specific injury characteristics. The aims of this study were to describe acute hip flexor injuries using magnetic resonance imaging (MRI) in athletes with acute groin pain and to compare specific muscle injuries with reported injury situations. Male athletes with acute groin pain were prospectively and consecutively included during three sports seasons. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. All athletes with an MRI confirmed acute hip flexor muscle injury were included. A total of 156 athletes presented with acute groin pain of which 33 athletes were included, median age 26 years (range 18-35). There were 16 rectus femoris, 12 iliacus, 7 psoas major, 4 sartorius, and 1 tensor fascia latae injury. Rectus femoris injuries primarily occurred during kicking (10) and sprinting (4), whereas iliacus injuries most frequently occurred during change of direction (5). In 10 (63%) rectus femoris injuries, tendinous injury was observed. The iliacus and psoas major injuries were mainly observed at the musculotendinous junction (MTJ), and two included tendinous injury. We have illustrated specific injury locations within these muscles, which may be relevant for the clinical diagnosis and prognosis of these injuries. Most proximal rectus femoris injuries included tendinous injury. In contrast, distinct acute iliacus and psoas injuries predominantly occurred at the MTJ. Only the iliacus or psoas major were injured during change of direction, whereas rectus femoris injuries occurred primarily during kicking and sprinting.
EVALuna2:36262

CHARACTERIZATION OF RELAPSES IN PATIENTS WITH GIANT CELL ARTERITIS (GCA) PATIENTS- DATA FROM THE REAL-LIFE TREATMENT AND SAFETY (REATS)-GCA COHORT - Schönau, Verena; Corte, Giulia; Ott, Sabine; Tascilar, Koray; Hartmann, F.; Manger, Bernhard; Hellmich, B.; Pfeil, A.; Oelzner, P.; Schmidt, W. A.; Krause, A.; Schmalzing, M.; et al. (ANNALS OF THE RHEUMATIC DISEASES, 2022)
CRIS-Team WoS Importer:2022-11-04

Characterization of the murine orthotopic adamantinomatous craniopharyngioma PDX model by MRI in correlation with histology - Hoelsken, Annett; Schwarz, Marc; Gillmann, Clarissa; Pfister, Christina; Uder, Michael; Dörfler, Arnd; Buchfelder, Michael; Schlaffer, Sven-Martin; Fahlbusch, Rudolf; Buslei, Rolf; Bäuerle, Tobias (PLoS ONE, 2018)
PURPOSE: Adamantinomatous craniopharyngiomas (ACP) as benign sellar brain tumors are challenging to treat. In order to develop robust in vivo drug testing methodology, the murine orthotopic craniopharyngioma model (PDX) was characterized by magnetic resonance imaging (MRI) and histology in xenografts from three patients (ACP1-3). METHODS: In ACP PDX, multiparametric MRI was conducted to assess morphologic characteristics such as contrast-enhancing tumor volume (CETV) as well as functional parameters from dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) including area-under-the-curve (AUC), peak enhancement (PE), time-to-peak (TTP) and apparent diffusion coefficient (ADC). These MRI parameters evaluated in 27 ACP PDX were correlated to histological features and percentage of vital tumor cell content. RESULTS: Qualitative analysis of MRI and histology from PDX revealed a similar phenotype as seen in patients, although the MRI appearance in mice resulted in a more solid tumor growth than in humans. CETV were significantly higher in ACP2 xenografts relative to ACP1 and ACP3 which correspond to respective average vitality of 41%, <10% and 26% determined histologically. Importantly, CETV prove tumor growth of ACP2 PDX as it significantly increases in longitudinal follow-up of 110 days. Furthermore, xenografts from ACP2 revealed a significantly higher AUC, PE and TTP in comparison to ACP3, and significantly increased ADC relative to ACP1 and ACP3 respectively. Overall, DCE-MRI and DWI can be used to distinguish vital from non-vital grafts, when using a cut off value of 15% for vital tumor cell content. CONCLUSIONS: MRI enables the assessment of craniopharyngioma PDX vitality in vivo as validated histologically.
EVALuna2:34588

Characterizing mammographic images by using generic texture features - Häberle, Lothar; Wagner, Florian; Fasching, Peter; Jud, Sebastian; Heusinger, Katharina; Löhberg, Christian; Hein, Alexander; Bayer, Christian M.; Hack, Carolin; Lux, Michael P.; Binder, Katja; Elter, Matthias; et al. (Breast Cancer Research, 2012)
Introduction: Although mammographic density is an established risk factor for breast cancer, its use is limited in clinical practice because of a lack of automated and standardized measurement methods. The aims of this study were to evaluate a variety of automated texture features in mammograms as risk factors for breast cancer and to compare them with the percentage mammographic density (PMD) by using a case-control study design.Methods: A case-control study including 864 cases and 418 controls was analyzed automatically. Four hundred seventy features were explored as possible risk factors for breast cancer. These included statistical features, moment-based features, spectral-energy features, and form-based features. An elaborate variable selection process using logistic regression analyses was performed to identify those features that were associated with case-control status. In addition, PMD was assessed and included in the regression model.Results: Of the 470 image-analysis features explored, 46 remained in the final logistic regression model. An area under the curve of 0.79, with an odds ratio per standard deviation change of 2.88 (95% CI, 2.28 to 3.65), was obtained with validation data. Adding the PMD did not improve the final model.Conclusions: Using texture features to predict the risk of breast cancer appears feasible. PMD did not show any additional value in this study. With regard to the features assessed, most of the analysis tools appeared to reflect mammographic density, although some features did not correlate with PMD. It remains to be investigated in larger case-control studies whether these features can contribute to increased prediction accuracy. © 2012 Fasching et al.; licensee BioMed Central Ltd.
CRIS-Team Scopus Importer:2021-07-19

CHARACTERIZING THE COMBINED EFFECT OF PHYSICAL ACTIVITY MEASURES ON STRUCTURAL PROGRESSION OF OA: THE MULTICENTER OSTEOARTHRITIS STUDY - Costello, K. E.; Guermazi, A.; Roemer, Frank; Lewis, C. E.; Torner, J. C.; Nevitt, M. C.; Felson, D. T.; Jafarzadeh, S. (OSTEOARTHRITIS AND CARTILAGE, 2022)
CRIS-Team WoS Importer:2022-04-22

Checkpoint inhibitor-induced eosinophilic fasciitis following high eosinophilia associated with complete response - Toussaint, Frédéric; Hammon, Matthias; Erdmann, Michael; Moreira, Alvaro; Kirchberger, Michael C.; Schuler, Gerold; Schett, Georg; Heinzerling, Lucie (Rheumatology, 2019)
CRIS-Team Scopus Importer:2019-10-01

Chemoprevention of Radiation-Induced DNA Double-Strand Breaks with Antioxidants - Kuefner, Michael Andreas; Brand, Michael; Andreassi, Maria Grazia; Braga, Larissa; Uder, Michael (Current Radiology Reports, 2015)
Double-strand breaks (DSB) are considered to be the most relevant X-ray-induced DNA damages. γ-H2AX immunofluorescence microscopy is a sensitive and reliable method for the quantification of distinct DSB. The detectable amount of these DNA damages correlates well with the dose received. A protective effect of different antioxidants has been postulated. This review explains the principle of the γ-H2AX technique, describes important results concerning DSB in radiologic examinations, and provides an overview on studies evaluating the effect of antioxidants on radiation-induced DNA damages with a special focus on recent studies using the γ-H2AX method.
CRIS-Team Scopus Importer:2023-03-08
Keywords: Antioxidants; Chemoprevention; DNA double-strand breaks; Radiation; γ-H2AX

Chronic Kidney Disease and Clinical Outcomes in Patients with Intracerebral Hemorrhage - Beuscher, Vanessa D.; Sprügel, Maximilian; Gerner, Stefan; Sembill, Jochen; Madzar, Dominik; Reindl, Caroline; Lücking, Hannes; Lang, Stefan; Kuramatsu, Joji; Huttner, Hagen; Hölter, Philip (Journal of Stroke and Cerebrovascular Diseases, 2020)
Background and Purpose: The influence of chronic kidney disease (CKD) on functional outcome in intracerebral hemorrhage (ICH) is scarcely investigated and reported findings are conflicting mostly because of nonaccounting for imbalances. Aim of the present study was to determine the impact of CKD on functional long-term outcome in ICH-patients. Methods: In this observational cohort study of spontaneous ICH-patients admitted to our Department of Neurology between 2006 and 2015 we investigated retrospectively as primary outcome the dichotomized functional status (modified-Rankin-Scale = 0-3-versus-4-6) at 12 months according to renal function (CKD versus non-CKD), including categorial estimates of the glomerular filtration rate subanalyses. Confounding was addressed by propensity-score(ps)-matching and adjusted multivariable regression analyses. Results: We identified 1076 eligible ICH-patients, of which 131 (12.2%) suffered from CKD on hospital admission. Confounders associated with CKD consisted of hypertension (P = .023), Diabetes mellitus (P = .001), prior ischemic stroke and/or transitory ischemic attack (TIA) (P = .021), congestive heart failure (P < .01), impaired liver function (P < .01), antiplatelet therapy (P = .01), poorer premorbid functional status (P < .01), and deep ICH-location (P = .006). After balancing for confounding, patients with CKD showed a significantly decreased rate of favorable functional outcome at 12 months (CKD:29 of 111(26.1%)-versus-non-CKD:78 of 206 (37.9%); P = .035). Subanalyses showed that stages of CKD were evenly associated with mortality at 12 months (GFR category G3a, OR:2.811; CI (1.130-6.994); P = .026; GFR category G3b, OR:1.874; CI (.694-5.058); P = .215; GFR category G4, OR:10.316; CI (1.976-53.856); P = .006; GFR category G5, OR:8.989; CI (1.900-42.518); P = .006). Conclusions: As compared to ICH-patients without CKD, those with CKD show increased rates of mortality and worse functional outcomes even after statistical correction for imbalanced baseline characteritsics. This finding is presumably linked to comorbidity and warrants further investigation in prospective studies.
CRIS-Team Scopus Importer:2020-04-28
Keywords: Chronic kidney disease; critical care; intracerebral hemorrhage; mortality; outcome

Chronic popliteal entrapment with calcified lesions results in an acute occlusion after blunt knee trauma in a 17-year-old soccer player - Regus, Susanne; Söder, Stephan; Janka, Rolf Matthias; Lang, Werner (Journal of Vascular Surgery, 2015)
EVALuna2:6687

Ciguatera fish poisoning: a first epidemic in Germany highlights an increasing risk for European countries - Mattei, Cesar; Vetter, Irina; Eisenblätter, Anneka; Krock, Bernd; Ebbecke, Martin; Desel, Herbert; Zimmermann, Katharina (Toxicon, 2014)
Toxin-producing microalgae are thriving worldwide due to coral reef destruction and global warming with major consequences on ecosystems, international trade and human health. Microalgae belonging to the family of flagellate protists, in particular dinoflagellates, secrete a variety of high-molecular-weight polyether toxins that accumulate through the marine food chain to cause disease in humans by acting as sodium channel activator toxins; ciguatera is the most frequent seafood-borne illness worldwide with 50,000 to 500,000 global incidences per annum and is usually limited to endemic areas located between 35° northern and 35° southern latitude. The rising global incidence frequency renders it a major human health problem, because no curative treatment is available yet and reliable detection assays are lacking. During the last decade ciguatera has increasingly become endemic in previously unaffected areas for two reasons: first global warming has contributed to the emergence of dinoflagellate species in subtropical and even temperate regions that previously had been constrained to tropical areas and second: in Europe globalization of fishing industry and tourism has led to a progressive increase in the number of ciguatera cases and a lack of awareness among medical personnel contributes to under-reporting. We review, through a recent ciguatera outbreak in Germany, the risk for ciguatera poisoning in Europe and highlight characteristic symptoms, current knowledge about disease pathomechanisms and treatment options.
EVALuna2:2368

Cinematic Rendering in Anatomy: A Crossover Study Comparing a Novel 3D Reconstruction Technique to Conventional Computed Tomography - Binder, Johannes; Scholz, Michael; Ellmann, Stephan; Uder, Michael; Grützmann, Robert; Krautz, Christian; Weber, Georg (Anatomical Sciences Education, 2020)
Integration of medical imaging into preclinical anatomy courses is already underway in many medical schools. However, interpretation of two-dimensional grayscale images is difficult and conventional volume rendering techniques provide only images of limited quality. In this regard, a more photorealistic visualization provided by Cinematic Rendering (CR) may be more suitable for anatomical education. A randomized, two-period crossover study was conducted from July to December 2018, at the University Hospital of Erlangen, Germany to compare CR and conventional computed tomography (CT) imaging for speed and comprehension of anatomy. Sixteen students were randomized into two assessment sequences. During each assessment period, participants had to answer 15 anatomy-related questions that were divided into three categories: parenchymal, musculoskeletal, and vascular anatomy. After a washout period of 14 days, assessments were crossed over to the respective second reconstruction technique. The mean interperiod differences for the time to answer differed significantly between the CR-CT sequence (-204.21 +/- 156.0 seconds) and the CT-CR sequence (243.33 +/- 113.83 seconds;P < 0.001). Overall time reduction by CR was 65.56%. Cinematic Rendering visualization of musculoskeletal and vascular anatomy was higher rated compared to CT visualization (P P = 0.003), whereas CT visualization of parenchymal anatomy received a higher scoring than CR visualization (P < 0.001). No carryover effects were observed. A questionnaire revealed that students consider CR to be beneficial for medical education. These results suggest that CR has a potential to enhance knowledge acquisition and transfer from medical imaging data in medical education.
CRIS-Team WoS Importer:2020-07-17

Cinematic Rendering in Mixed-Reality Holograms: A New 3D Preoperative Planning Tool in Pediatric Heart Surgery - Gehrsitz, Pia; Rompel, Oliver; Schoeber, Martin; Cesnjevar, Robert; Purbojo, Ariawan; Uder, Michael; Dittrich, Sven; Alkassar, Muhannad (Frontiers in Cardiovascular Medicine, 2021)
Cinematic rendering (CR) is based on a new algorithm that creates a photo-realistic three-dimensional (3D) picture from cross-sectional images. Previous studies have shown its positive impact on preoperative planning. To date, CR presentation has only been possible on 2D screens which limited natural 3D perception. To depict CR-hearts spatially, we used mixed-reality technology and mapped corresponding hearts as holograms in 3D space. Our aim was to assess the benefits of CR-holograms in the preoperative planning of cardiac surgery. Including 3D prints allowed a direct comparison of two spatially resolved display methods. Twenty-six patients were recruited between February and September 2019. CT or MRI was used to visualize the patient's heart preoperatively. The surgeon was shown the anatomy in cross-sections on a 2D screen, followed by spatial representations as a 3D print and as a high-resolution hologram. The holographic representation was carried out using mixed-reality glasses (HoloLens (R)). To create the 3D prints, corresponding structures were segmented to create STL files which were printed out of resin. In 22 questions, divided in 5 categories (3D-imaging effect, representation of pathology, structure resolution, cost/benefit ratio, influence on surgery), the surgeons compared each spatial representation with the 2D method, using a five-level Likert scale. The surgical preparation time was assessed by comparing retrospectively matched patient pairs, using a paired t-test. CR-holograms surpassed 2D-monitor imaging in all categories. CR-holograms were superior to 3D prints in all categories (mean Likert scale 4.4 +/- 1.0 vs. 3.7 +/- 1.3, P < 0.05). Compared to 3D prints it especially improved the depth perception (4.7 +/- 0.7 vs. 3.7 +/- 1.2) and the representation of the pathology (4.4 +/- 0.9 vs. 3.6 +/- 1.2). 3D imaging reduced the intraoperative preparation time (n = 24, 59 +/- 23 min vs. 73 +/- 43 min, P < 0.05). In conclusion, the combination of an extremely photo-realistic presentation via cinematic rendering and the spatial presentation in 3D space via mixed-reality technology allows a previously unattained level of comprehension of anatomy and pathology in preoperative planning.
CRIS-Team WoS Importer:2021-03-12

Cinematic rendering in rheumatic diseases-Photorealistic depiction of pathologies improves disease understanding for patients - Pachowsky, Milena; Morf, Harriet; Simon, David; Schönau, Verena; Valor-Mendez, Larissa; Knitza, Johannes; Fagni, Filippo; Engel, Klaus; Uder, Michael; Hueber, Axel; Schmidkonz, Christian; Schett, Georg; et al. (Frontiers in Medicine, 2022)
BackgroundPatient education is crucial for successful chronic disease management. Current education material for rheumatic patients however rarely includes images of disease pathologies, limiting patients' disease understanding. Cinematic rendering (CR) is a new tool that allows segmentation of standard medical images (DICOMs) into pictures that illustrate disease pathologies in a photorealistic way. Thus CR has the potential to simplify and improve the explanation of disease pathologies, disease activity and disease consequences and could therefore be a valuable tool to effectively educate and inform patients about their rheumatic and musculoskeletal disease (RMD). ObjectivesTo examine the feasibility of creating photorealistic images using CR from RMD patients depicting typical rheumatic disease pathologies and, in a second step to investigate the patient-perceived educational potential of these photorealistic images in clinical routine. MethodsWe selected conventional, high-resolution (HR) and positron emission tomography (PET) computed tomography (CT) images of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axSpA), and giant cell arteritis (GCA) that showed typical respective disease pathologies. These images were segmented using CR technique. In a prospective study, physicians used CR-enhanced and conventional original images to explain the depicted pathognomonic pathologies to patients with the respective rheumatic disease. Patients were then asked to complete a questionnaire evaluating the perceived usefulness of being presented with CR-enhanced images to better understand their underlying disease. ResultsCR images were successfully generated from above mentioned CT methods. Pathologies such as bone erosions, bony spurs, bone loss, ankylosis, and PET-based inflammation could be visualized in photorealistic detail. A total of 79 patients (61% females) with rheumatic diseases (RA 29%, PsA 29%, axSpA 24%, GCA 18%) were interviewed and answered the quantitative questionnaire. Mean age was 55.4 +/- 12.6 years. Irrespective of disease, all patients agreed or highly agreed that CR-based images help to improve disease understanding, should be shown at disease onset, provide a rationale to regularly take medication and would like to have access to their own CR-enhanced images. ConclusionConventional disease images can successfully be turned into photorealistic disease depictions using CR. Patients perceived CR images as a valuable addition to current patient education, enabling personalized disease education and potentially increased medication adherence.
CRIS-Team WoS Importer:2022-08-26

Circulating micro-RNAs as potential blood-based markers for early stage breast cancer detection - Schrauder, Michael G.; Strick, Reiner; Schulz-Wendtland, Rüdiger; Strissel, Pamela; Kahmann, Laura; Loehberg, Christian R.; Lux, Michael P.; Jud, Sebastian; Hartmann, Arndt; Hein, Alexander; Bayer, Christian M.; Bani, Mayada; et al. (PLoS ONE, 2012)
Introduction: MicroRNAs (miRNAs, miRs) are a class of small, non-coding RNA molecules with relevance as regulators of gene expression thereby affecting crucial processes in cancer development. MiRNAs offer great potential as biomarkers for cancer detection due to their remarkable stability in blood and their characteristic expression in many different diseases. We investigated whether microarray-based miRNA profiling on whole blood could discriminate between early stage breast cancer patients and healthy controls. Methods: We performed microarray-based miRNA profiling on whole blood of 48 early stage breast cancer patients at diagnosis along with 57 healthy individuals as controls. This was followed by a real-time semi-quantitative Polymerase Chain Reaction (RT-qPCR) validation in a separate cohort of 24 early stage breast cancer patients from a breast cancer screening unit and 24 age matched controls using two differentially expressed miRNAs (miR-202, miR-718). Results: Using the significance level of p<0.05, we found that 59 miRNAs were differentially expressed in whole blood of early stage breast cancer patients compared to healthy controls. 13 significantly up-regulated miRNAs and 46 significantly down-regulated miRNAs in our microarray panel of 1100 miRNAs and miRNA star sequences could be detected. A set of 240 miRNAs that was evaluated by radial basis function kernel support vector machines and 10-fold cross validation yielded a specificity of 78.8%, and a sensitivity of 92.5%, as well as an accuracy of 85.6%. Two miRNAs were validated by RT-qPCR in an independent cohort. The relative fold changes of the RT-qPCR validation were in line with the microarray data for both miRNAs, and statistically significant differences in miRNA-expression were found for miR-202. Conclusions: MiRNA profiling in whole blood has potential as a novel method for early stage breast cancer detection, but there are still challenges that need to be addressed to establish these new biomarkers in clinical use. © 2012 Schrauder et al.
CRIS-Team Scopus Importer:2021-07-19

Classification-based summation of cerebral digital subtraction angiography series for image post-processing algorithms - Schuldhaus, Dominik; Spiegel, Martin; Redel, T.; Polyanskaya, Maria; Struffert, Tobias; Hornegger, Joachim; Dörfler, Arnd (Physics in Medicine and Biology, 2011)
X-ray-based 2D digital subtraction angiography (DSA) plays a major role in the diagnosis, treatment planning and assessment of cerebrovascular disease, i.e. aneurysms, arteriovenous malformations and intracranial stenosis. DSA information is increasingly used for secondary image post-processing such as vessel segmentation, registration and comparison to hemodynamic calculation using computational fluid dynamics. Depending on the amount of injected contrast agent and the duration of injection, these DSA series may not exhibit one single DSA image showing the entire vessel tree. The interesting information for these algorithms, however, is usually depicted within a few images. If these images would be combined into one image the complexity of segmentation or registration methods using DSA series would drastically decrease. In this paper, we propose a novel method automatically splitting a DSA series into three parts, i.e. mask, arterial and parenchymal phase, to provide one final image showing all important vessels with less noise and moving artifacts. This final image covers all arterial phase images, either by image summation or by taking the minimum intensities. The phase classification is done by a two-step approach. The mask/arterial phase border is determined by a Perceptron-based method trained from a set of DSA series. The arterial/parenchymal phase border is specified by a threshold-based method. The evaluation of the proposed method is two-sided: (1) comparison between automatic and medical expert-based phase selection and (2) the quality of the final image is measured by gradient magnitudes inside the vessels and signal-to-noise (SNR) outside. Experimental results show a match between expert and automatic phase separation of 93%/50% and an average SNR increase of up to 182% compared to summing up the entire series. © 2011 Institute of Physics and Engineering in Medicine.

Classification of Breast Cancer Histology Images Using Transfer Learning - Vesal, Sulaiman; Ravikumar, Nishant; Davari, Amirabbas; Ellmann, Stephan; Maier, Andreas (ICIAR 2018: Image Analysis and Recognition, 2018)

Classification of neurovascular compression in glossopharyngeal neuralgia: Three-dimensional visualization of the glossopharyngeal nerve - Tanrikulu, Levent; Hastreiter, Peter; Dörfler, Arnd; Buchfelder, Michael; Naraghi, Ramin (Surgical Neurology International, 2015)
Background: We introduce a method of noninvasive topographical analysis of the neurovascular relationships of the glossopharyngeal nerve (CN IX) by three-dimensional (3D) visualization. Patients with glossopharyngeal neuralgia (GN) resulting from neurovascular compression (NVC) were studied. Methods: 15 patients with GN were prospectively examined with 3D visualization using high-resolution magnetic resonance imaging with constructive interference in steady state (MR-CISS). The datasets were segmented and visualized with the real, individual neurovascular relationships by direct volume rendering. Segmentation and 3D visualization of the CN IX and corresponding blood vessels were performed. The 3D visualizations were interactively compared with the intraoperative setup during microvascular decompression (MVD) in order to verify the results by the observed surgical-anatomical findings. Results: 15 patients (female/male: 5/10) were examined. All of them underwent MVD (100%). Microvascular details were documented. The posterior inferior cerebellar artery (PICA) was the most common causative vessel in 12 of 15 patients (80%), the vertebral artery (VA) alone in one case (6.7%), and the combination of compression by the VA and PICA in 3 patients (13.3%). We identified three distinct types of NVC within the root entry zone of CN IX. Conclusion: 3D visualization by direct volume rendering of MR-CISS data offers the opportunity of noninvasive exploration and anatomical categorization of the CN IX. It proves to be advantageous in supporting to establish the diagnosis and microneurosurgical interventions by representing original, individual patient data in a 3D fashion. It provides an excellent global individual view over the entire neurovascular relationships of the brainstem and corresponding nerves in each case.
CRIS-Team Scopus Importer:2022-08-05
Keywords: Classification; glossopharyngeal nerve; glossopharyngeal neuralgia; image processing; neurovascular compression

Classification of primary cerebral lymphoma and glioblastoma featuring dynamic susceptibility contrast and apparent diffusion coefficient - Eisenhut, Felix; Schmidt, Manuel; Putz, Florian; Lettmaier, Sebastian; Fröhlich, Kilian; Arinrad, Soheil; Coras, Roland; Lücking, Hannes; Lang, Stefan; Fietkau, Rainer; Dörfler, Arnd (Brain Sciences, 2020)
This study aimed to differentiate primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) via multimodal MRI featuring radiomic analysis. MRI data sets of patients with histological proven PCNSL and GBM were analyzed retrospectively. Diffusion-weighted imaging (DWI) and dynamic susceptibility contrast (DSC) perfusion imaging were evaluated to differentiate contrast enhancing intracerebral lesions. Selective (contrast enhanced tumor area with the highest mean cerebral blood volume (CBV) value) and unselective (contouring whole contrast enhanced lesion) Apparent diffusion coefficient (ADC) measurement was performed. By multivariate logistic regression, a multiparametric model was compiled and tested for its diagnostic strength. A total of 74 patients were included in our study. Selective and unselective mean and maximum ADC values, mean and maximum CBV and ratioCBV as quotient of tumor CBV and CBV in contralateral healthy white matter were significantly larger in patients with GBM than PCNSL; minimum CBV was significantly lower in GBM than in PCNSL. The highest AUC for discrimination of PCNSL and GBM was obtained for selective mean and maximum ADC, mean and maximum CBV and ratioCBV. By integrating these five in a multiparametric model 100% of the patients were classified correctly. The combination of perfusion imaging (CBV) and tumor hot-spot selective ADC measurement yields reliable radiological discrimination of PCNSL from GBM with highest accuracy and is readily available in clinical routine.
CRIS-Team Scopus Importer:2020-12-04
Keywords: ADC; DSC; Glioblastoma; MRI; Multimodal; Primary central nervous system lymphoma

CLASSIFICATION OF PSORIATIC ARTHRITIS, SERONEGATIVE RHEUMATOID ARTHRITIS, AND SEROPOSITIVE RHEUMATOID ARTHRITIS USING DEEP LEARNING ON MAGNETIC RESONANCE IMAGING - Folle, Lukas; Bayat, Sara; Kleyer, Arnd; Fagni, Filippo; Kapsner, Lorenz; Schlereth, Maja; Meinderink, Timo; Breininger, Katharina; Tascilar, Koray; Krönke, Gerhard; Uder, Michael; Sticherling, Michael; et al. (Supplement 1, 2022)
Background: While MRI evaluation of joints has been primarily used to quantify inflammation at a cross-sectional and longitudinal level, less is known about the potential of MRI in distinguishing different patterns of inflammation in the various forms of arthritis. Objectives: To evaluate (i) whether deep learning using neural networks can be trained to distinguish between seropositive rheumatoid arthritis (RA+), seronegative RA (RA-), and psoriatic arthritis (PsA) based on structural inflammatory patterns on hand magnetic resonance imaging and (ii) to assess if psoriasis patients with subclinical inflammation fit into such patterns. Methods: ResNet 3D [1] neural networks were trained to distinguish (i) RA+ vs. PsA, (ii) RA- vs. PsA and (iii) RA+ vs. RA- with respect to hand MRI data. Diagnosis of patients was determined using the following guidelines: ACR/EULAR 2010 [2] for RA and CASPAR [3] for PsA. Results from T1 coronal, T2 coronal, T1 coronal and axial fat suppressed contrast-enhanced (CE) and T2 fat suppressed axial sequences were used. The performance of such trained networks was analyzed by the area-under-the-receiver-operating-characteristic curve (AUROC) with and without imputation of demographic and clinical parameters ( Figure 1A ). Additionally, the trained networks were applied to psoriasis patients without clinical signs of PsA. Results: MRI scans from 649 patients (135 RA-, 190 RA+, 177 PsA, 147 psoriasis) were included ( Table 1 ). The AUROC for differentiation between disease entities was 75% (SD 3%) for RA+ vs. PsA, 74% (SD 8%) for RA- vs. PsA, and 67% (6%) for RA+ vs. RA-. All MRI sequences were relevant for classification, however, when deleting CE sequences, the loss of performance was only marginal. The addition of patient-specific data to the networks did not provide significant improvements. Increasing amounts of training data demonstrated improved performance of the networks ( Figure 1B ). Psoriasis patients were mostly assigned to PsA by the neural networks, suggesting that PsA-like MRI pattern may be present early in the course of psoriatic disease. Conclusion: Deep learning can be successfully applied to differentiate MRI inflammatory patterns related to RA+, RA-, and PsA. Early changes in psoriasis patients can be recognized by neural networks and are characterized by a pattern that allowed the networks to classify them as PsA. <
Keywords: Rheumatoid arthritis; deep learning; neural networks

Clinical and radiological outcome after mechanical thrombectomy in acute ischemic stroke: What matters? - Kaschka, Iris; Kloska, Stephan; Struffert, Tobias; Engelhorn, Tobias; Gölitz, Philipp; Kurka, Natalia; Köhrmann, Martin; Schwab, Stefan; Dörfler, Arnd (Neuroradiology Journal, 2016)
Recent studies have shown the efficacy of mechanical thrombectomy in acute ischemic stroke. We sought to identify prognostic parameters for clinical and radiological outcome after mechanical thrombectomy.In 34 patients (age 72 ± 13 years, 64.7% women) with acute occlusion of the distal ICA and/or M1 segment who were treated with mechanical thrombectomy, the Spearman correlation was performed to assess potential prognostic outcome parameters (age, NIHSS, ASPECT, thrombus length (TL), clot burden score (CBS), relative filling time delay (rFTD), time to recanalization (TTR) and TICI score). The modified Rankin scale (mRS) and the Alberta Stroke Program Early CT (ASPECT) score were used for clinical and radiological outcome, respectively. Receiver operating characteristic (ROC) analysis was performed to assess parameters predicting favorable clinical (?mRS <= 2) and radiological outcome (?ASPECT <= 2).Variables associated with favorable clinical outcome included NIHSS, TL, TTR and TICI score (p <= 0.01) with NIHSS <= 15 (p = 0.001, area under the curve (AUC) 0.87), TL <= 2 cm (p = 0.017, AUC 0.75), TTR <= 231 min (p = 0.001 AUC 0.88) and TICI >= 2b (p = 0.050, AUC 0.70). Shorter TTR and higher TICI scores were associated with favorable radiological outcome (p < 0.001) with TTR <= 224 min (p = 0.023, AUC 0.77) and TICI >= 2b (p = 0.000, AUC 0.86).Fast and complete recanalization is essential to achieve a favorable radiological and functional outcome after mechanical thrombectomy in acute ischemic stroke. Age, CBS and collateral supply play a subordinate role.
EVALuna2:22544

Clinical Application of Ultrahigh-Field-Strength Wrist MRI: A Multireader 3-T and 7-T Comparison Study - Heiß, Rafael; Weber, Marc-Andre; Balbach, Eva; Schmitt, Rainer; Rehnitz, Christoph; Laqmani, Azien; Sternberg, Andreas; Ellermann, Jutta J.; Nagel, Armin Michael; Ladd, Mark E.; Englbrecht, Matthias; Arkudas, Andreas; et al. (Radiology, 2023)
Background Ultrahigh-field-strength MRI at 7 T may permit superior visualization of noninflammatory wrist pathologic conditions, particularly due to its high signal-to-noise ratio compared with the clinical standard of 3 T, but direct comparison studies are lacking. Purpose To compare the subjective image quality of 3-T and 7-T ultrahigh-field-strength wrist MRI through semiquantitative scoring of multiple joint tissues in a multireader study. Materials and Methods In this prospective study, healthy controls and participants with chronic wrist pain underwent 3-T and 7-T MRI (coronal T1-weighted turbo spin-echo [TSE], coronal fat-suppressed proton-density [PD]-weighted TSE, transversal T2-weighted TSE) on the same day, from July 2018 to June 2019. Images were scored by seven musculoskeletal radiologists. The overall image quality, presence of artifacts, homogeneity of fat suppression, and visualization of cartilage, the triangular fibrocartilage complex (TFCC), and scapholunate and lunotriquetral ligaments were semiquantitatively assessed. Pairwise differences between 3 T and 7 T were assessed using the Wilcoxon signed-rank test. Interreader reliability was determined using the Fleiss kappa. Results In total, 25 healthy controls (mean age, 25 years ± 4 [SD]; 13 women) and 25 participants with chronic wrist pain (mean age, 39 years ± 16; 14 men) were included. Overall image quality (P = .002) and less presence of artifacts at PD-weighted fat-suppressed MRI were superior at 7 T. T1- and T2-weighted MRI were superior at 3 T (both P < .001), as was fat suppression (P < .001). Visualization of cartilage was superior at 7 T (P < .001), while visualization of the TFCC (P < .001) and scapholunate (P = .048) and lunotriquetral (P = .04) ligaments was superior at 3 T. Interreader reliability showed slight to substantial agreement for the detected pathologic conditions (κ = 0.20-0.64). Conclusion A 7-T MRI of the wrist had potential advantages over 3-T MRI, particularly in cartilage assessment. However, superiority was not shown for all parameters; for example, visualization of the triangular fibrocartilage complex and wrist ligaments was superior at 3 T. © RSNA, 2023 Supplemental material is available for this article.
CRIS-Team Scopus Importer:2023-04-21

Clinical Comparison of FD-CT and MS-CT in Aneurysmal Subarachnoid Haemorrhage: A Single Center Experience - Eisenhut, Felix; Heidelbach, Cornelius; Heynold, Elisabeth; Manhart, Michael; Struffert, Tobias; Brandner, Sebastian; Dörfler, Arnd; Lang, Stefan (Diagnostics, 2022)
Single-center comparison of postinterventional multislice computed tomography (MS-CT) and flat-detector computed tomography (FD-CT) in patients with subarachnoid haemorrhage (SAH) and endovascularly treated cerebral aneurysms with a focus on detection of posttherapeutical complications. Patients with endovascularly treated aneurysmal SAH undergoing both MS-CT and FD-CT within 24 h after intervention were included. Datasets were compared regarding image quality (IQ) as well as qualitative (detection of SAH, intracerebral haemorrhage [ICH], intraventricular haemorrhage [IVH], external ventricular drain [EVD] position, acute obstructive hydrocephalus [AOH]) and quantitative (cella media distance [CMD], modified Graeb score [GS]) parameters. 410 patients with endovascularly treated aneurysmal SAH were included. IQ was equal between MS-CT and FD-CT. FD-CT allowed equal detection of SAH and ICH in comparison to MS-CT. FD-CT allowed excellent detection of IVH and delineation of EVD position with strong agreement to MS-CT findings. FD-CT allowed equal detection of AOH in comparison to MS-CT. There was no significant difference of CMD and GS between FD-CT and MS-CT. Postinterventional FD-CT yields equivalent diagnostic value in patients with endovascular treated SAH as MS-CT. Enabling reliable detection of SAH-associated complications within the angiosuite, FD-CT might be an efficient and safe imaging modality in these clinical emergencies.
CRIS-Team Scopus Importer:2022-11-04
Keywords: cerebral aneurysm; endovascular treatment; flat-detector computed tomography; multislice computed tomography; subarachnoid haemorrhage

Clinical Evaluation of an Innovative Metal-Artifact-Reduction Algorithm in FD-CT Angiography in Cerebral Aneurysms Treated by Endovascular Coiling or Surgical Clipping - Eisenhut, Felix; Schmidt, Manuel; Kalik, Alexander; Struffert, Tobias; Feulner, Julian; Schlaffer, Sven-Martin; Manhart, Michael; Dörfler, Arnd; Lang, Stefan (Diagnostics, 2022)
Treated cerebral aneurysms (IA) require follow-up imaging to ensure occlusion. Metal artifacts complicate radiologic assessment. Our aim was to evaluate an innovative metal-artifact-reduction (iMAR) algorithm for flat-detector computed tomography angiography (FD-CTA) regarding image quality (IQ) and detection of aneurysm residua/reperfusion in comparison to 2D digital subtraction angiography (DSA). Patients with IAs treated by endovascular coiling or clipping underwent both FD-CTA and DSA. FD-CTA datasets were postprocessed with/without iMAR algorithm (MAR+/MAR−). Evaluation of all FD-CTA and DSA datasets regarding qualitative (IQ, MAR) and quantitative (coil package diameter/CPD) parameters was performed. Aneurysm occlusion was assessed for each dataset and compared to DSA findings. In total, 40 IAs were analyzed (ncoiling = 24; nclipping = 16). All iMAR+ datasets demonstrated significantly better IQ (pIQ coiling < 0.0001; pIQ clipping < 0.0001). iMAR significantly reduced the metal-artifact burden but did not affect the CPD. iMAR significantly improved the detection of aneurysm residua/reperfusion with excellent agreement with DSA (naneurysm detection MAR+/MAR−/DSA = 22/1/26). The iMAR algorithm significantly improves IQ by effective reduction of metal artifacts in FD-CTA datasets. The proposed algorithm enables reliable detection of aneurysm residua/reperfusion with good agreement to DSA. Thus, iMAR can help to reduce the need for invasive follow-up in treated IAs.
CRIS-Team Scopus Importer:2022-05-27
Keywords: cerebral aneurysm; endovascular coiling; flat-detector computed tomography angiography; metal-artifact-reduction algorithm; surgical clipping

Clinical evaluation of semi-automatic landmark-based lesion tracking software for CT-scans - Dankerl, Peter; Dietzel, Matthias; Tsymbal, Alexey; Kramer, Martin; Seifert, Sascha; Uder, Michael; Hammon, Matthias; Cavallaro, Alexander Josef (Cancer Imaging, 2014)
To evaluate a semi-automatic landmark-based lesion tracking software enabling navigation between RECIST lesions in baseline and follow-up CT-scans.The software automatically detects 44 stable anatomical landmarks in each thoraco/abdominal/pelvic CT-scan, sets up a patient specific coordinate-system and cross-links the coordinate-systems of consecutive CT-scans. Accuracy of the software was evaluated on 96 RECIST lesions (target- and non-target lesions) in baseline and follow-up CT-scans of 32 oncologic patients (64 CT-scans). Patients had to present at least one thoracic, one abdominal and one pelvic RECIST lesion. Three radiologists determined the deviation between lesions' centre and the software's navigation result in consensus.The initial mean runtime of the system to synchronize baseline and follow-up examinations was 19.4 ± 1.2 seconds, with subsequent navigation to corresponding RECIST lesions facilitating in real-time. Mean vector length of the deviations between lesions' centre and the semi-automatic navigation result was 10.2 ± 5.1 mm without a substantial systematic error in any direction. Mean deviation in the cranio-caudal dimension was 5.4 ± 4.0 mm, in the lateral dimension 5.2 ± 3.9 mm and in the ventro-dorsal dimension 5.3 ± 4.0 mm.The investigated software accurately and reliably navigates between lesions in consecutive CT-scans in real-time, potentially accelerating and facilitating cancer staging.
EVALuna2:14438

Clinically compatible subject-specific dynamic parallel transmit pulse design for homogeneous fat saturation and water-excitation at 141657T: Proof-of-concept for 14165CEST MRI of the brain - Levy, Simon; Herrler, Jürgen; Liebert, Andrzej; Tkotz, Katharina; Fabian, Moritz; Eisen, Christian; Grodzki, David; Uder, Michael; Dörfler, Arnd; Zaiß, Moritz; Nagel, Armin Michael (Magnetic Resonance in Medicine, 2022)
Purpose To evaluate the benefits and challenges of dynamic parallel transmit (pTx) pulses for fat saturation (FS) and water-excitation (WE), in the context of CEST MRI. Methods "Universal" k(T)-points (for FS) and spiral non-selective (for WE) trajectories were optimized offline for flip angle (FA) homogeneity. Routines to optimize the pulse shape online, based on the subject's fields maps, were implemented (target FA of 110 degrees/0 degrees for FS, 0 degrees/5 degrees for WE at fat/water frequencies). The pulses were inserted in a CEST sequence with a pTx readout. The different fat suppression schemes and their effects on CEST contrasts were compared in 12 volunteers at 7T. Results With a 25%-shorter pulse duration, pTx FS largely improved the FA homogeneity (root-mean-square-error (RMSE) = 12.3 degrees vs. 53.4 degrees with circularly-polarized mode, at the fat frequency). However, the spectral selectivity was degraded mainly in the cerebellum and close to the sinuses (RMSE = 5.8 degrees vs. 0.2 degrees at the water frequency). Similarly, pTx WE showed a trade-off between FA homogeneity and spectral selectivity compared to pTx non-selective pulses (RMSE = 0.9 degrees and 1.1 degrees at the fat and water frequencies, vs. 4.6 degrees and 0.5 degrees). In the brain, CEST metrics were reduced by up to 31.9% at -3.3 ppm with pTx FS, suggesting a mitigated lipid-induced bias. Conclusion This clinically compatible implementation of dynamic pTx pulses improved the fat suppression homogeneity at 7T taking into account the subject-specific B-0 heterogeneities online. This study highlights the lipid-induced biases on the CEST z-spectrum. The results are promising for body applications where B-0 heterogeneities and fat are more substantial.
CRIS-Team WoS Importer:2022-09-30

Clinically significant CMV (re)activation during or after radiotherapy/chemotherapy of the brain : Correlation with neurological deterioration and improvement upon antiviral treatment - Goerig, Nicole; Semrau, S.; Frey, Benjamin; Korn, Klaus; Fleckenstein, Bernhard; Überla, Klaus; Dörfler, Arnd; Putz, Florian; Gaipl, Udo; Fietkau, Rainer (Strahlentherapie und Onkologie, 2016)
For both patients with high-grade gliomas and multiple cerebral metastases, radio(chemo)therapy is the standard therapy. Neurological decline during treatment is rarely attributed to infections of the brain but to tumor progression or side effects of radiotherapy.We present 4 cases of cytomegalovirus (CMV) viremia associated with neurological deterioration, which occurred during or shortly after radiotherapy and/or chemotherapy of the brain (brain metastases 2, high-grade glioma 1, carcinoma infiltrating brain 1). In all cases, neurological decline was sudden and unexpected, and causes such as increased intracranial pressure or tumor progression could be excluded radiologically. Treatment with dexamethasone and mannitol had no or only very short-term effects. General infections were either excluded or receding before the neurological symptoms occurred. All patients presented with decreasing levels of thrombocytes. In all cases, CMV (re)activation could be proven using blood test for CMV-DNA. The anti-CMV-IgG status suggested reactivation rather than a primary infection. One patient died within 72 h of onset of the symptoms (results of CMV tests were received postmortem). Diagnosis of 3 patients allowed successful administration of antiviral treatment, which greatly improved the general and neurological conditions of the patients within 48 h.Neurological deterioration during RT is hardly ever attributed to viral infections. These cases suggest that CMV reactivation and subsequent infection might actually be causative and has to be considered and treated.Further prospective studies verifying and investigating this observation in terms of frequency and clinical relevance seem indicated.
EVALuna2:8302

Clinical Outcome and Quality of Life of Multimodal Treatment of Extracranial Arteriovenous Malformations: The APOLLON Study Protocol - Schmidt, Vanessa F.; Masthoff, Max; Vielsmeier, Veronika; Seebauer, Caroline T.; Cangir, Ozlem; Meyer, Lutz; Muekke, Antje; Lang, Werner; Schmid, Axel; Sporns, Peter B.; Brill, Richard; Wohlgemuth, Walter A.; et al. (Cardiovascular and Interventional Radiology, 2022)
Purpose Arteriovenous malformations (AVMs) as rare diseases are diagnostically and therapeutically challenging. Due to the limited evidence regarding treatment outcome, prospective data are needed on how different treatment regimens affect outcome. The aims of this prospective trial are to determine effectiveness, safety, and clinical outcome of multimodal treatment in patients with extracranial AVMs.
CRIS-Team WoS Importer:2022-11-04

Clinical outcome of patients with orbital fractures treated with patient specific CAD/CAM ceramic implants – A retrospective study - Falkhausen, Runa; Mitsimponas, Konstantinos; Adler, Werner; Brand, Michael; von Wilmowsky, Cornelius (Journal of Cranio-Maxillofacial Surgery, 2021)
The aim of this study was to determine whether patients benefit from a secondary reconstruction since it carries the risks of no improvement or worsening of their current situation. Patients treated with individual computer-aided-design/computer-aided-manufacturing (CAD/CAM) ceramic implants were reviewed. To ascertain changes throughout the secondary reconstruction, the study investigators reviewed ophthalmological examinations, took volumetric measurements of the orbits and asked the patients for evaluation of their situation before and after the reconstruction. Points addressed were double vision, visual acuity, field of vision, limitations in daily life and aesthetic considerations. A total of 14 patients were reviewed and 11 answered the questionnaire. Ophthalmological examinations showed that the physical integrity of the eye was maintained. Volumetric measurements preopeatively (33.94 ± 3.24 cm3) and postoperatively (30.67 ± 2.07 cm3) showed that a statistically significant overcorrection of orbital volume leads to good functional and aesthetic outcomes. Patients’ subjective opinions were that they greatly benefitted, especially concerning limitations in daily life, which improved by 4.4 ± 2.8 points out of 10 possible points, and aesthetics, with an improvement of 5.9 ± 1.78 points. Based on these findings, we conclude that secondary reconstructions contribute to improvement of the patients’ quality of life and therefore should be considered as an option to improve patients’ condition.
CRIS-Team Scopus Importer:2021-03-26
Keywords: Clinical outcome; Patient reported outcome; Patient specific implant; Secondary orbital reconstruction

Clinical, patient-reported, radiographic and magnetic resonance imaging findings 11 years after acute posterior cruciate ligament injury treated non-surgically - Brown, Jamie S.; Mogianos, Krister; Roemer, Frank; Isacsson, Anders; Kumm, Jaanika; Frobell, Richard; Olsson, Ola; Englund, Martin (BMC Musculoskeletal Disorders, 2023)
Background: Long-term consequences of posterior cruciate ligament (PCL) injury such as persistent posterior tibial translation and risk of osteoarthritis development are unclear. Additionally, little data is available describing the natural history of structural morphology of the ruptured PCL. The purpose of the study was to determine the long-term outcome after non-operatively treated PCL injury. Methods: Over 6-years, all acute knee injuries were documented by subacute MRI (median 8 days [5–15, 25th − 75th percentile] from injury to MRI). Twenty-six patients with acute PCL injury were identified of whom 18 (69%) participated in the long-term follow-up after 11 years. Follow-up included radiographic posterior tibial translation (RPTT) determined using the Puddu axial radiograph. weight-bearing knee radiographs, MRI and KOOS (Knee injury and Osteoarthritis Outcome Score). Results: On subacute MRI, 11 knees displayed total and 7 partial ruptures. At 11 (SD 1.9) years, the median RPTT was 3.7 mm (1.5–6.3, 25th − 75th percentile). Seven knees displayed radiographic osteoarthritis approximating Kellgren-Lawrence grade ≥ 2. All follow-up MRIs displayed continuity of the PCL. Patients with more severe RPTT (> 3.7 mm), had worse scores in the KOOS subscales for symptoms (mean difference 14.5, 95% CI 7–22), sport/recreation (30, 95% CI 0–65) and quality of life (25, 95% CI 13–57) than those with less severe RPTT (≤ 3.7 mm). This was also the case for the KOOS4 (22, 95% CI 9–34). Conclusion: Acute PCL injuries treated non-surgically display a high degree of PCL continuity on MR images 11 years after injury. However, there is a large variation of posterior tibial translation with higher values being associated with poorer patient-reported outcomes.
CRIS-Team Scopus Importer:2023-05-26
Keywords: Long-term outcome; Non-surgical treatment; Posterior cruciate ligament

Clinical/perfusion CT CBV mismatch as prognostic factor in intraarterial thrombectomy in acute anterior circulation stroke - Saake, Marc; Breuer, Lorenz; Gölitz, Philipp; Köhrmann, Martin; Schwab, Stefan; Dörfler, Arnd; Kloska, Stephan (Clinical Neurology and Neurosurgery, 2014)
Contradictory results were reported for the outcome after endovascular recanalization (ERT) in acute anterior circulation ischemic stroke. We assessed whether a clinical/perfusion CT cerebral blood volume (CBV) mismatch concept (CPM) can identify patients who will benefit from reperfusion therapy.Imaging and clinical data of 58 consecutive ERT cases with acute anterior circulation stroke (ICA, M1, proximal M2) undergoing intraarterial thrombectomy within 4.5h after symptom onset were analyzed retrospectively. CPM was defined as NIHSS>=8 and PCT CBV ASPECTS>=7. Minor CBV lesion was defined as PCT CBV ASPECTS>=7.All baseline characteristics other than blood glucose did not differ between the paired groups. Revascularization was achieved in 87.9% of all patients without significant difference between the paired groups. Favorable clinical outcome after 3 months (mRS<=2) resulted in 29.3% of all patients, in contrast to 47.4% of the CPM positive and 52.2% of the minor CBV lesion groups.CPM can identify patients who will benefit from reperfusion therapy in acute anterior circulation ischemic stroke.
EVALuna2:14386

Clinical relevance of total choline (tCho) quantification in suspicious lesions on multiparametric breast MRI - Sodano, Claudia; Clauser, Paola; Dietzel, Matthias; Kapetas, Panagiotis; Pinker, Katja; Helbich, Thomas H.; Gussew, Alexander; Baltzer, Pascal Andreas (European Radiology, 2020)
Purpose: To assess the additional value of quantitative tCho evaluation to diagnose malignancy and lymph node metastases in suspicious lesions on multiparametric breast MRI (mpMRI, BI-RADS 4, and BI-RADS 5). Methods: One hundred twenty-one patients that demonstrated suspicious multiparametric breast MRI lesions using DCE, T2w, and diffusion-weighted (DW) images were prospectively enrolled in this IRB-approved study. All underwent single-voxel proton MR spectroscopy (1H-MRS, point-resolved spectroscopy sequence, TR 2000 ms, TE 272 ms) with and without water suppression. The total choline (tCho) amplitude was measured and normalized to millimoles/liter according to established methodology by two independent readers (R1, R2). ROC-analysis was employed to predict malignancy and lymph node status by tCho results. Results: One hundred three patients with 74 malignant and 29 benign lesions had full 1H-MRS data. The area under the ROC curve (AUC) for prediction of malignancy was 0.816 (R1) and 0.809 (R2). A cutoff of 0.8 mmol/l tCho could diagnose malignancy with a sensitivity of > 95%. For prediction of lymph node metastases, tCho measurements achieved an AUC of 0.760 (R1) and 0.788 (R2). At tCho levels < 2.4 mmol/l, no metastatic lymph nodes were found. Conclusion: Quantitative tCho evaluation from 1H-MRS allowed diagnose malignancy and lymph node status in breast lesions suspicious on multiparametric breast MRI. tCho therefore demonstrated the potential to downgrade suspicious mpMRI lesions and stratify the risk of lymph node metastases for improved patient management. Key Points: • Quantitative tCho evaluation can distinguish benign from malignant breast lesions suspicious after multiparametric MRI assessment. • Quantitative tCho levels are associated with lymph node status in breast cancer. • Quantitative tCho levels are higher in hormonal receptor positive compared to hormonal receptor negative lesions.
CRIS-Team Scopus Importer:2020-02-28
Keywords: Breast neoplasms; Magnetic resonance imaging; Magnetic resonance spectroscopy; Prognosis; Sensitivity and specificity

Clinical routine acquisition protocol for 3D relaxation-compensated APT and rNOE CEST-MRI of the human brain at 3T - Goerke, Steffen; Breitling, Johannes; Korzowski, Andreas; Paech, Daniel; Zaiß, Moritz; Schlemmer, Heinz-Peter; Ladd, Mark E.; Bachert, Peter (Magnetic Resonance in Medicine, 2021)
Purpose The value of relaxation-compensated amide proton transfer (APT) and relayed nuclear Overhauser effect (rNOE) chemical exchange saturation transfer (CEST)-MRI has already been demonstrated in various neuro-oncological clinical applications. Recently, we translated the approach from 7T to a clinically relevant magnetic field strength of 3T. However, the overall acquisition time was still too long for a broad application in the clinical setting. The aim of this study was to establish a shorter acquisition protocol whilst maintaining the contrast behavior and reproducibility.
CRIS-Team WoS Importer:2021-02-26

Clinical/scientific notes - Möller, Sebastian; Hilz, Max-Josef; Blinzler, C.; Köhn, Julia; Dörfler, Arnd; Schwab, Stefan; Köhrmann, Martin (Neurology, 2012)
CRIS-Team Scopus Importer:2022-08-05

Clinical significance of worsening versus stable preradiographic MRI lesions in a cohort study of persons at higher risk for knee osteoarthritis - Sharma, Leena; Nevitt, Michael; Hochberg, Marc; Guermazi, Ali; Roemer, Frank; Crema, Michel; Eaton, Charles; Jackson, Rebecca; Kwoh, Kent; Cauley, Jane; Almagor, Orit; Chmiel, Joan S. (Annals of the Rheumatic Diseases, 2016)
Whether preradiographic lesions in knees at risk for osteoarthritis are incidental versus disease is unclear. We hypothesised, in persons without but at higher risk for knee osteoarthritis, that: 12-48 month MRI lesion status worsening is associated with 12-48 month incident radiographic osteoarthritis (objective component of clinical definition of knee osteoarthritis) and 48-84 month persistent symptoms.In 849 Osteoarthritis Initiative participants Kellgren/Lawrence (KL) 0 in both knees, we assessed cartilage damage, bone marrow lesions (BMLs), and menisci on 12 month (baseline) and 48 month MRIs. Multivariable logistic regression was used to evaluate associations between 12-48 month worsening versus stable status and outcome (12-48 month incident KL >=1 and KL >=2, and 48-84 month persistent symptoms defined as frequent symptoms or medication use most days of >=1 month in past 12 month, at consecutive visits 48-84 months), adjusting for age, gender, body mass index (BMI), injury and surgery.Mean age was 59.6 (8.8), BMI 26.7 (4.2) and 55.9% were women. 12-48 month status worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs was associated with 12-48 month incident radiographic outcomes, and worsening of cartilage damage and BMLs with 48-84 month persistent symptoms. There was a dose-response association for magnitude of worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs and radiographic outcomes, and cartilage damage and BMLs and persistent symptoms.In persons at higher risk, worsening MRI lesion status was associated with concurrent incident radiographic osteoarthritis and subsequent persistent symptoms. These findings suggest that such lesions represent early osteoarthritis, and add support for a paradigm shift towards investigation of intervention effectiveness at this stage.
EVALuna2:14634

CLIPPERS with longitudinally extensive transverse myelitis: Role of T versus B cells - Olmes, David G.; Metz, Imke; Lee, De-Hyung; Rosenwald, Andreas; Dörfler, Arnd; Brueck, Wolfgang; Linker, Ralf (Journal of the Neurological Sciences, 2018)
EVALuna2:35521

Clonogenicity-based radioresistance determines the expression of immune suppressive immune checkpoint molecules after hypofractionated irradiation of MDA-MB-231 triple-negative breast cancer cells - Gehre, Simon; Meyer, Felix; Sengedorj, Azzaya; Grottker, Fridolin; Reichardt, Clara; Alomo, Jannik; Borgmann, Kerstin; Frey, Benjamin; Fietkau, Rainer; Rückert, Michael; Gaipl, Udo (Frontiers in Oncology, 2023)
Only a subset of patients with triple-negative breast cancer (TNBC) benefits from a combination of radio- (RT) and immunotherapy. Therefore, we aimed to examine the impact of radioresistance and brain metastasizing potential on the immunological phenotype of TNBC cells following hypofractionated RT by analyzing cell death, immune checkpoint molecule (ICM) expression and activation of human monocyte-derived dendritic cells (DCs). MDA-MB-231 triple-negative breast cancer tumor cells were used as model system. Apoptosis was the dominant cell death form of brain metastasizing tumor cells, while Hsp70 release was generally significantly increased following RT and went along with necrosis induction. The ICMs PD-L1, PD-L2, HVEM, ICOS-L, CD137-L and OX40-L were found on the tumor cell surfaces and were significantly upregulated by RT with 5 x 5.2 Gy. Strikingly, the expression of immune suppressive ICMs was significantly higher on radioresistant clones compared to their respective non-radioresistant ones. Although hypofractionated RT led to significant cell death induction and release of Hsp70 in all tumor cell lines, human monocyte-derived DCs were not activated after co-incubation with RT-treated tumor cells. We conclude that radioresistance is a potent driver of immune suppressive ICM expression on the surface of TNBC MDA-MB-231 cells. This mechanism is generally known to predominantly influence the effector phase, rather than the priming phase, of anti-tumor immune responses.
CRIS-Team Scopus Importer:2023-05-19
Keywords: breast cancer; dendritic cells; immune checkpoint molecules; radioresistance; radiotherapy; tumor cell death

Closed disruption of a single flexor digitorum superficialis tendon slip: 3 cases - Schweizer, A.; Bayer, T. (Hand Surgery and Rehabilitation, 2019)
Two men and one woman (age 31, 36 and 45 years) felt a painful pop in the left middle, right middle and right index finger during sport-related activities (2 sport climbing and 1 judo). Clinical examination found a painful flexor tendon in zone 2 but no function deficit specific to the flexor digitorum superficialis (FDS) tendon. MRI and ultrasonography revealed a complete disruption of the radial FDS tendon slip only, which was found retracted between the A2 and A3 pulleys. All flexor tendon pulleys remained intact. Conservative and functional treatment resulted in unrestricted normal function and return to sport. Disruption of one FDS tendon slip is a differential diagnosis for a popping incident in the finger, which is typically associated with a closed flexor tendon pulley injury. (C) 2019 SFCM. Published by Elsevier Masson SAS. All rights reserved.
CRIS-Team WoS Importer:2019-04-04

Closed disruption of a single flexor digitorum superficialis tendon slip; 3 cases (Rupture d'une seule bandelette tendineuse du flexor digitorum superficialis : 3 cas) - Schweizer, A.; Bayer, T. (Hand Surgery and Rehabilitation, 2019)
Two men and one woman (age 31, 36 and 45 years) felt a painful pop in the left middle, right middle and right index finger during sport-related activities (2 sport climbing and 1 judo). Clinical examination found a painful flexor tendon in zone 2 but no function deficit specific to the flexor digitorum superficialis (FDS) tendon. MRI and ultrasonography revealed a complete disruption of the radial FDS tendon slip only, which was found retracted between the A2 and A3 pulleys. All flexor tendon pulleys remained intact. Conservative and functional treatment resulted in unrestricted normal function and return to sport. Disruption of one FDS tendon slip is a differential diagnosis for a popping incident in the finger, which is typically associated with a closed flexor tendon pulley injury.
CRIS-Team Scopus Importer:2019-05-02
Keywords: Claquement tendon fléchisseur; Closed distal FDS tendon single slip disruption; Closed flexor tendon disruption; Closed flexor tendon injury related to sports; Flexor digitorum superficialis; Flexor digitorum superficialis; lésion fermée de la partie radiale du tendon fléchisseur superficiel; Lésion fermée du tendon fléchisseur au sport; lésion fermée du tendon fléchisseur superficiel; Popping of flexor tendon; Rupture du tendon fléchisseur superficiel des doigts

Clot Burden and Collaterals in Anterior Circulation Stroke: Differences Between Single-Phase CTA and Multi-phase 4D-CTA - Kaschka, Iris; Kloska, Stephan; Struffert, Tobias; Engelhorn, Tobias; Gölitz, Philipp; Kurka, Natalia; Köhrmann, Martin; Schwab, Siegfried; Dörfler, Arnd (Clinical Neuroradiology, 2014)
It has been reported that the extent of intravascular thrombi and the quality of collateral filling in computed tomography (CT) angiography are predictive for the clinical outcome in patients with acute stroke. We hypothesized that multi-phase four-dimensional CTA (4D-CTA) allows better assessment of clot burden and collateral flow compared with arterial single-phase CTA (CTA).In 49 patients (33 female; age: 77 ± 12 years) with acute anterior circulation stroke, CTA and 4D-CTA reconstructed from dynamic perfusion CT data were analyzed for absolute thrombus length (TL), clot burden score (CBS), and collateral score (CS). The length of the filling defect was also defined on thin-slice nonenhanced CT as corresponding hyperdense middle cerebral artery sign (HMCAS) when present.There was good correlation (r = 0.62, p < 0.01) between the length of HMCAS (1.29 ± 0.62 cm) and TL in 4D-CTA (1.22 ± 0.51 cm). 4D-CTA and CTA significantly varied (p < 0.01) in TL (1.42 ± 0.73 cm (CTA) versus 1.11 ± 0.62 cm (4D-CTA)), CBS (median: 5, interquartile range: 4-7 (CTA) versus median: 6, interquartile range: 5-8 (4D-CTA); p < 0.001), and CS (median: 2, interquartile range: 1-2 (CTA) versus median: 3, interquartile range: 2-3 (4D-CTA); p < 0.001). Accordingly, CTA significantly overrated clot burden and underestimated collateral flow.4D-CTA more closely defines clot burden and collateral supply in anterior circulation stroke than CTA, implicating an additional diagnostic benefit.
EVALuna2:22276

Cluster Analysis of Glaucoma Patients Using the Retinal Nerve Fiber Layer Thickness of the Optic Nerve and DTI Parameters of the Optic Radiation - Michelson, Georg; Wärntges, Simone; Engelhorn, Tobias; El-Rafei, Ahmed Mohamed Ibrahim; Hornegger, Joachim; Dörfler, Arnd (Clinical and Experimental Ophthalmology, 2011)

c-MRI findings after crystal meth abuse - Möbius, Cornelia; Kustermann, Andreas; Struffert, Tobias; Kornhuber, Johannes; Mueller, Helge H. (Journal of Addiction Medicine, 2014)
We describe a case of intoxication with N-methylamphetamine (Crystal-METH) after withdrawal. Crystal-METH abuse was associated with persisting neurological symptoms and impressive structural white matter alterations. Magnetic resonance imaging should be recommended to document the possible extensive changes in amphetamine abuse, which increases dramatically.
EVALuna2:22312

Combination of an ultrafast TWIST-VIBE Dixon sequence protocol and diffusion-weighted imaging into an accurate easily applicable classification tool for masses in breast MRI - Peter, Sandra C.; Wenkel, Evelyn; Weiland, Elisabeth; Dietzel, Matthias; Janka, Rolf Matthias; Hartmann, Arndt; Emons, Julius; Uder, Michael; Ellmann, Stephan (European Radiology, 2020)
Objectives: This study aimed to develop a tool for the classification of masses in breast MRI, based on ultrafast TWIST-VIBE Dixon (TVD) dynamic sequences combined with DWI. TVD sequences allow to abbreviate breast MRI protocols, but provide kinetic information only on the contrast wash-in, and because of the lack of the wash-out kinetics, their diagnostic value might be hampered. A special focus of this study was thus to maintain high diagnostic accuracy in lesion classification. Materials and methods: Sixty-one patients who received breast MRI between 02/2014 and 04/2015 were included, with 83 reported lesions (60 malignant). Our institute’s standard breast MRI protocol was complemented by an ultrafast TVD sequence. ADC and peak enhancement of the TVD sequences were integrated into a generalised linear model (GLM) for malignancy prediction. For comparison, a second GLM was calculated using ADC and conventional DCE curve type. The resulting GLMs were evaluated for standard diagnostic parameters. For easy application of the GLMs, nomograms were created. Results: The GLM based on peak enhancement of the TVD and ADC was as equally accurate as the GLM based on conventional DCE and ADC, with no significant differences (sensitivity, 93.3%/93.3%; specificity, 91.3%/87.0%; PPV, 96.6%/94.9%; NPV, 84.0%/83.3%; all, p ≥ 0.315). Conclusions: This study presents a method to integrate ultrafast TVD sequences into a breast MRI protocol, allowing a reduction of the examination time while maintaining diagnostic accuracy. A GLM based on the combination of TVD-derived peak enhancement and ADC provides high diagnostic accuracy, and can be easily applied using a nomogram. Key Points: • Ultrafast TWIST-VIBE Dixon sequence protocols in combination with diffusion-weighted imaging allow to shorten breast MRI examinations, while diagnostic accuracy is maintained. • Integrating peak enhancement from the TWIST-VIBE Dixon sequence and the apparent diffusion coefficient into a generalised linear model provides a comprehensible image evaluation approach. • This approach is further facilitated by nomograms.
CRIS-Team Scopus Importer:2020-02-11
Keywords: Breast cancer; Diagnostic imaging; Diffusion magnetic resonance imaging; Magnetic resonance imaging; Statistical model

Combinatorial drug treatments reveal promising anticytomegaloviral profiles for clinically relevant pharmaceutical kinase inhibitors (PKIs) - Wild, Markus; Kicuntod, Jintawee; Seyler, Lisa; Wangen, Christina; Bertzbach, Luca D.; Conradie, Andelé M.; Kaufer, Benedikt B.; Wagner, Sabrina; Michel, Detlef; Eickhoff, Jan; Tsogoeva, Svetlana; Bäuerle, Tobias; et al. (International Journal of Molecular Sciences, 2021)
Human cytomegalovirus (HCMV) is a human pathogenic herpesvirus associated with a variety of clinical symptoms. Current antiviral therapy is not always effective, so that improved drug classes and drug-targeting strategies are needed. Particularly host-directed antivirals, including pharmaceutical kinase inhibitors (PKIs), may help to overcome problems of drug resistance. Here, we focused on utilizing a selection of clinically relevant PKIs and determined their anticytomegaloviral efficacies. Particularly, PKIs directed to host or viral cyclin-dependent kinases, i.e., abemaciclib, LDC4297 and maribavir, exerted promising profiles against human and murine cytomegaloviruses. The anti-HCMV in vitro activity of the approved anti-cancer drug abemaciclib was confirmed in vivo using our luciferase-based murine cytomegalovirus (MCMV) animal model in immunocompetent mice. To assess drug combinations, we applied the Bliss independence checkerboard and Loewe additivity fixed-dose assays in parallel. Results revealed that (i) both affirmative approaches provided valuable information on anti-CMV drug efficacies and interactions, (ii) the analyzed combinations comprised additive, synergistic or antagonistic drug interactions consistent with the drugs’ antiviral mode-of-action, (iii) the selected PKIs, especially LDC4297, showed promising inhibitory profiles, not only against HCMV but also other α-, β-and γ-herpesviruses, and specifically, (iv) the combination treatment with LDC4297 and maribavir revealed a strong synergism against HCMV, which might open doors towards novel clinical options in the near future. Taken together, this study highlights the potential of therapeutic drug combinations of current developmental/preclinical PKIs.
CRIS-Team Scopus Importer:2021-01-22
Keywords: Activity in vitro and in vivo; Antiviral drugs; Combinatorial drug analyses; Human cytomegalovirus; New synergistic combinations; Pharmaceutical kinase inhibitors (PKIs)

Combined diffusion-relaxometry microstructure imaging: Current status and future prospects - Slator, Paddy J.; Palombo, Marco; Miller, Karla L.; Westin, Carl-Fredrik; Laun, Frederik Bernd; Kim, Daeun; Haldar, Justin P.; Benjamini, Dan; Lemberskiy, Gregory; De Almeida Martins, Joao P.; Hutter, Jana (Magnetic Resonance in Medicine, 2021)
Microstructure imaging seeks to noninvasively measure and map microscopic tissue features by pairing mathematical modeling with tailored MRI protocols. This article reviews an emerging paradigm that has the potential to provide a more detailed assessment of tissue microstructure—combined diffusion-relaxometry imaging. Combined diffusion-relaxometry acquisitions vary multiple MR contrast encodings—such as b-value, gradient direction, inversion time, and echo time—in a multidimensional acquisition space. When paired with suitable analysis techniques, this enables quantification of correlations and coupling between multiple MR parameters—such as diffusivity, (Formula presented.), (Formula presented.), and (Formula presented.). This opens the possibility of disentangling multiple tissue compartments (within voxels) that are indistinguishable with single-contrast scans, enabling a new generation of microstructural maps with improved biological sensitivity and specificity.
CRIS-Team Scopus Importer:2021-08-27
Keywords: diffusion; multidimensional MRI; quantitative MRI; relaxometry

Combined imaging of potassium and sodium in human skeletal muscle tissue at 7 T - Gast, Lena; Volker, Stefanie; Utzschneider, Matthias; Linz, Peter; Wilferth, Tobias; Müller, Max; Kopp, Christoph; Hensel, Bernhard; Uder, Michael; Nagel, Armin Michael (Magnetic Resonance in Medicine, 2020)
Purpose: To validate the feasibility of quantitative combined potassium (39K) and sodium (23Na) MRI in human calf muscle tissue, as well as to evaluate the reproducibility of the apparent tissue potassium concentration (aTPC) and apparent tissue sodium concentration (aTSC) determination in healthy muscle tissue. Methods: Quantitative 23Na and 39K MRI acquisition protocols were implemented on a 7 T MR system. A double-resonant 23Na/39K birdcage RF coil was used. Measurements of human lower leg were performed in a total acquisition time of TANa = 10:54 min/TAK = 8:06 min and using a nominal spatial resolution of 2.5 × 2.5 × 15 mm3/7.5 × 7.5 × 30 mm3 for 23Na/39K MRI. Two aTSC and aTPC examinations in muscle tissue were performed during the same day on 10 healthy subjects. Results: The proposed acquisition and postprocessing workflow for 23Na and 39K MRI data sets provided reproducible aTSC and aTPC measurements. In human calf muscle tissue, the coefficient of variation between scan and re-scan was 5.7% for both aTSC and aTPC determination. Overall, mean values of aTSC = (17 ± 1) mM and aTPC = (85 ± 5) mM were measured. Moreover, for 39K in calf muscle tissue, (Formula presented.) components of (Formula presented.) = (1.2 ± 0.2) ms and (Formula presented.) = (7.9 ± 0.9) ms, as well as a residual quadrupolar interaction of (Formula presented.) = (143 ± 17) Hz, were determined. The fraction of the fast component was f = (58 ± 4)%. Conclusion: Using the presented measurement and postprocessing approach, a reproducible aTSC and aTPC determination using 23Na and 39K MRI at 7 T in human skeletal muscle tissue is feasible in clinically acceptable acquisition durations.
CRIS-Team Scopus Importer:2020-09-11
Keywords: 7 T; potassium MRI; sodium MRI; tissue potassium concentration; tissue sodium concentration; ultrahigh field strengths

Combined reading of Contrast Enhanced and Diffusion Weighted Magnetic Resonance Imaging by using a simple sum score - Baltzer, Anja; Dietzel, Matthias; Kaiser, Clemens G.; Baltzer, Pascal A. (European Radiology, 2016)
OBJECTIVE: To improve specificity of breast MRI by integrating Apparent Diffusion Coefficient (ADC) values with contrast enhanced MRI (CE-MRI) using a simple sum score. METHODS: Retrospective analysis of a consecutive series of patients referred to breast MRI at 1.5 T for further workup of breast lesions. Reading results of CE-MRI were dichotomized into score 1 (suspicious) or 0 (benign). Lesion's ADC-values (in *10-3 mm2/s) were assigned two different scores: ADC2: likely malignant (score +1, ADC ≤ 1), indeterminate (score 0, ADC >1- ≤ 1.4) and likely benign (score -1, ADC > 1.4) and ADC1: indeterminate (score 0, ADC ≤ 1.4) and likely benign (score -1, ADC > 1.4). Final added CE-MRI and ADC scores >0 were considered suspicious. Reference standard was histology and imaging follow-up of >24 months. Diagnostic parameters were compared using McNemar tests. RESULTS: A total of 150 lesions (73 malignant) were investigated. Reading of CE-MRI showed a sensitivity of 100 % (73/73) and a specificity of 81.8 % (63/77). Additional integration of ADC scores increased specificity (ADC2/ADC1, P = 0.008/0.001) without causing false negative results. CONCLUSION: Using a simple sum score, ADC-values can be integrated with CE-MRI of the breast, improving specificity. The best approach is using one threshold to exclude cancer. KEY POINTS: ADC is used to assign levels of suspicion to breast lesions. ADC values >1.4 *10 (-3) mm (2) /s are likely benign and effectively rule out malignancy. ADC values below ≤1*10 (-3) mm (2) /s) are likely malignant but may be false positive. CE-MRI (+1: suspicious, 0: benign) and ADC (0: indeterminate, -1: benign) scores are added. Sum scores >0 should be biopsied.
EVALuna2:33226

Comparative analysis of titanium clip prostheses for partial ossiculoplasty - Mantsopoulos, Konstantinos; Thimsen, Vivian; Taha, Lava; Eisenhut, Felix; Müller-Hübner, Sarina; Sievert, Matti; Iro, Heinrich; Hornung, Joachim (American Journal of Otolaryngology, 2021)
Objectives: The aim of our study was to perform a comparative analysis in our cases with titanium partial clip ossiculoplasty in terms of audiometric outcome and extrusion rates as well as to review the literature for relevant information on this surgical issue. Materials and methods: The records of all patients who had undergone primary partial ossiculoplasty with the implantation of a CliP® Partial Prosthesis Dresden Type (CPPDT, group A) or a CliP Partial FlexiBAL® (CPF, Group B, both Heinz Kurz GmbH, Dusslingen, Germany) between 2012 and 2020 were studied retrospectively. Results: 274 patients made up our study sample (148 men, 126 women, male to female ratio: 1.17). Their mean age at the time of first surgery was 39.6 years (range: 4–79 years). The mean preoperative air-bone gap (ABG) was 22.7dΒ ± 10.5 dB. Mean follow-up was approximately 4 months (1–12 months). The mean postoperative ABG was 15.7 ± 8.1 dB. In total, the postoperative ABG was significantly improved compared to preoperative values (P < 0.001). Surgical success, defined as an ABG ≤ 20 dB, was achieved in the majority of our study patients (210/274, 76.6%). Extrusion of the prosthesis was detected in 3/216 CPF and 5/58 CPPDT cases (p = 0.012). Comparison of both prosthesis groups revealed a significantly better audiological outcome for the patients with ossicular reconstruction using CPF. A significantly better audiological outcome was detected in the cases with a normal aeration of the middle ear. Discussion: Titanium clip partial ossiculoplasty is a reliable component of modern tympanoplasty, allowing a satisfying audiologic outcome. The higher adaptability of the CPF to the changing postoperative circumstances and the frequently defective aeration of the middle ear is reflected in the better audiologic outcome for this prosthesis.
CRIS-Team Scopus Importer:2021-04-30
Keywords: Air-bone gap; Middle ear; Ossiculoplasty; Outcome; Partial prosthesis; PORP

Comparative analysis of unsupervised algorithms for breast MRI lesion segmentation - Vesal, Sulaiman; Ravikumar, Nishant; Ellmann, Stephan; Maier, Andreas (Informatik aktuell, 2018)
Accurate segmentation of breast lesions is a crucial step in evaluating the characteristics of tumors. However, this is a challenging task, since breast lesions have sophisticated shape, topological structure, and variation in the intensity distribution. In this paper, we evaluated the performance of three unsupervised algorithms for the task of breast Magnetic Resonance (MRI) lesion segmentation, namely, Gaussian Mixture Model clustering, K-means clustering and a markercontrolled Watershed transformation based method. All methods were applied on breast MRI slices following selection of regions of interest (ROIs) by an expert radiologist and evaluated on 106 subject’s images, which include 59 malignant and 47 benign lesions. Segmentation accuracy was evaluated by comparing our results with ground truth masks, using the Dice similarity coefficient (DSC), Jaccard index (JI), Hausdorff distance and precision-recall metrics. The results indicate that the marker-controlled Watershed transformation outperformed all other algorithms investigated.
CRIS-Team Scopus Importer:2022-06-05

Comparative fMRI and MEG localization of cortical sensorimotor function: Bimodal mapping supports motor area reorganization in glioma patients - Zimmermann, Max; Roessler, Karl; Kaltenhaeuser, Martin; Grummich, Peter; Brandner, Nadja; Buchfelder, Michael; Dörfler, Arnd; Kölble, Konrad; Stadlbauer, Andreas (PLoS ONE, 2019)
Introduction
CRIS-Team WoS Importer:2019-03-26

Comparative Study of 2D-Cine and 3D-wh Volumetry: Revealing Systemic Error of 2D-Cine Volumetry - Alkassar, Muhnnad; Engelhardt, Sophia; Abu-Tair, Tariq; Ojeda, Efren; Treffer, Philipp C.; Weyand, Michael; Rompel, Oliver (Diagnostics, 2023)
This study investigates the crucial factors influencing the end-systolic and end-diastolic volumes in MRI volumetry and their direct effects on the derived functional parameters. Through the simultaneous acquisition of 2D-cine and 3D whole-heart slices in end-diastole and end-systole, we present a novel direct comparison of the volumetric measurements from both methods. A prospective study was conducted with 18 healthy participants. Both 2D-cine and 3D whole-heart sequences were obtained. Despite the differences in the creation of 3D volumes and trigger points, the impact on the LV volume was minimal (134.9 mL ± 16.9 mL vs. 136.6 mL ± 16.6 mL, p < 0.01 for end-diastole; 50.6 mL ± 11.0 mL vs. 51.6 mL ± 11.2 mL, p = 0.03 for end-systole). In our healthy patient cohort, a systematic underestimation of the end-systolic volume resulted in a significant overestimation of the SV (5.6 mL ± 2.6 mL, p < 0.01). The functional calculations from the 3D whole-heart method proved to be highly accurate and correlated well with function measurements from the phase-contrast sequences. Our study is the first to demonstrate the superiority of 3D whole-heart volumetry over 2D-cine volumetry and sheds light on the systematic error inherent in 2D-cine measurements.
CRIS-Team Scopus Importer:2023-11-10
Keywords: 2D-cine MRI; 3D-wh MRI; cardiac volumetry

Comparing 1.5 T and 3.0 T MR data for 3D visualization of neurovascular relationships in the posterior fossa - Hastreiter, Peter; Maliachova, Olga; Fahlbusch, Rudolf; Dörfler, Arnd; Buchfelder, Michael; Naraghi, Ramin (Acta Neurochirurgica, 2023)
Background: Neurovascular relationships in the posterior fossa are more frequently investigated due to the increasing availability of 3.0 Tesla MRI. For an assessment with 3D visualization, no systematic analyzes are available so far and the question arises as to whether 3.0 Tesla MRI should be given preference over 1.5 Tesla MRI. Methods: In a prospective study, a series of 25 patients each underwent MRI investigations with 3D-CISS and 3D-TOF at 1.5 and 3.0 Tesla. For both field strengths separately, blood vessel information from the TOF data was fused into the CISS data after segmentation and registration. Four visualizations were created for each field strength, with and without optimization before and after fusion, which were evaluated with a rating system and verified with the intraoperative situation. Results: When only CISS data was used, nerves and vessels were better visualized at 1.5 Tesla. After fusion, flow and pulsation artifacts were reduced in both cases, missing vessel sections were supplemented at 3.0 Tesla and 3D visualization at 1.5 and 3.0 Tesla led to anatomically comparable results. By subsequent manual correction, the remaining artifacts were further eliminated, with the 3D visualization being significantly better at 3.0 Tesla, since the higher field strength led to sharper contours of small vessel and nerve structures. Conclusion: 3D visualizations at 1.5 Tesla are sufficiently detailed for planning microvascular decompression and can be used without restriction. Fusion further improves the quality of 3D visualization at 3.0 Tesla and enables an even more accurate delineation of cranial nerves and vessels.
CRIS-Team Scopus Importer:2023-12-29
Keywords: 1.5 and 3.0 Tesla; 3D Visualization; Compression syndromes; Data fusion; Neurovascular relationships; Posterior fossa

Comparing axial CT slices in quantized N-dimensional SURF descriptor space to estimate the visible body region - Feulner, Johannes; Zhou, S. Kevin; Angelopoulou, Elli; Seifert, Sascha; Hornegger, Joachim; Comaniciu, Dorin; Cavallaro, Alexander Josef (Computerized Medical Imaging and Graphics, 2011)
In this paper, a method is described to automatically estimate the visible body region of a computed tomography (CT) volume image. In order to quantify the body region, a body coordinate (BC) axis is used that runs in longitudinal direction. Its origin and unit length are patient-specific and depend on anatomical landmarks. The body region of a test volume is estimated by registering it only along the longitudinal axis to a set of reference CT volume images with known body coordinates. During these 1D registrations, an axial image slice of the test volume is compared to an axial slice of a reference volume by extracting a descriptor from both slices and measuring the similarity of the descriptors. A slice descriptor consists of histograms of visual words. Visual words are code words of a quantized feature space and can be thought of as classes of image patches with similar appearance. A slice descriptor is formed by sampling a slice on a regular 2D grid and extracting a Speeded Up Robust Features (SURF) descriptor at each sample point. The codebook, or visual vocabulary, is generated in a training step by clustering SURF descriptors. Each SURF descriptor extracted from a slice is classified into the closest visual word (or cluster center) and counted in a histogram. A slice is finally described by a spatial pyramid of such histograms. We introduce an extension of the SURF descriptors to an arbitrary number of dimensions (N-SURF). Here, we make use of 2-SURF and 3-SURF descriptors. Cross-validation on 84 datasets shows the robustness of the results. The body portion can be estimated with an average error of 15.5. mm within 9. s. Possible applications of this method are automatic labeling of medical image databases and initialization of subsequent image analysis algorithms. © 2010 Elsevier Ltd.

Comparing the effects of isocaloric oral and i.v. application of nutrient solutions on olfactory functioning - Bachlechner, Stephan; Denzer-Lippmann, M.; Wielopolski, Jan; Fische, Mr; Büttner, Andrea; Dörfler, Arnd; Schöfl, Christof; Münch, Georg; Kornhuber, Johannes; Thürauf, Norbert (2016)
EVALuna2:33154

Comparison between open and pharmacomechanical repair of acutely thrombosed arteriovenous hemodialysis fistulae within a decade - Regus, Susanne; Almási-Sperling, Veronika; Rother, Ulrich; Meyer, Alexander; Schmid, Axel; Uder, Michael; Lang, Werner (Hemodialysis International, 2018)
INTRODUCTION: Different declotting techniques are available for acutely thrombosed arteriovenous hemodialysis fistulae (AVF). The aim of this single-center study was to compare immediate and follow-up results between surgical repair and a modified interventional lyse-and-wait technique characterized by prolonged local reaction times of recombinant tissue-plasminogen activator (rtPA). MATERIALS AND METHODS: We retrospectively analyzed medical records of 110 consecutively treated patients between the years 2003 and 2013. All patients were on hemodialysis (HD) and suffered from an acutely thrombosed AVF. The treatment standards changed in the course of time, wherefore we compared 2 groups: the open repair (OR) (N = 50) and the endovascular repair (ER) group (N = 60). FINDINGS: We found no significant differences in success rates (OR 92%/ER 96.7%; P = 0.28), immediate failures (IFs) (OR 8%/ER 10%; P = 0.71), and temporary catheter placements (TCPs) (OR 10%/ER 6.7%; P = 0.52). Furthermore, there were no differences in cumulative primary patency rates (P = 0.42) and secondary patency rates (P = 0.97).The infection rate was significantly increased after OR (8%) compared to ER (0%); P = 0.026. The hospital stay in days was shorter after ER (5.2 ±2.8) vs. OR (9.0 ± 3.5); P < 0.001. CONCLUSION: The modified lyse-and-wait technique with prolonged local reaction times is a successful alternative to surgical repair for acutely thrombosed AVF. Clear benefits are less infections and significant shorter hospital stays after ER. However, OR remains the preferred treatment for aneurysms and anastomotic stenoses.
EVALuna2:36234

Comparison between semiquantitative and quantitative methods for the assessment of knee synovitis in osteoarthritis using non-enhanced and gadolinium-enhanced MRI - Crema, M. D.; Roemer, Frank; Li, L.; Alexander, R. C.; Chessell, I. P.; Dudley, A. D.; Karlsten, R.; Rosen, L. B.; Guermazi, Ali (Osteoarthritis and Cartilage, 2017)
To compare different semiquantitative and quantitative methods using both non-enhanced and gadolinium-enhanced MRI techniques for the assessment of synovitis in knee osteoarthritis (OA).Knees with end-stage clinical OA in patients undergoing total knee replacement surgery were included in this cross-sectional study. MRI was performed on all knees. Standard non-enhanced and gadolinium-enhanced sequences were acquired. Using non-enhanced MRI, we semiquantitatively assessed two features widely used as surrogates for synovitis: effusion-synovitis and Hoffa-synovitis. Using gadolinium-enhanced sequences, we semiquantitatively assessed synovial thickness. We quantitatively evaluated the total synovial volume on the gadolinium-enhanced sequences as well. We assessed the correlations of effusion-synovitis and Hoffa-synovitis with synovial thickness and volume, applying Spearman correlation analysis. The diagnostic performance of both synovitis features on non-enhanced MRI was assessed using synovial thickness on gadolinium-enhanced MRI as the reference.A total of 104 subjects (one knee per subject) were included. Correlations of effusion-synovitis with synovial thickness and volume were r = 0.41 and r = 0.43 (P < .001) r = 0.32 and r = 0.39 (P < .0001).Using synovial thickness assessed on gadolinium-enhanced sequences as the reference, effusion-synovitis showed superior correlations and sensitivity. Effusion-synovitis should be preferred over Hoffa-synovitis as a surrogate marker for synovial thickening, in studies of knee OA for which gadolinium-enhanced sequences are not available.
EVALuna2:14698

Comparison in knee osteoarthritis joint damage patterns among individuals with an intact, complete and partial anterior cruciate ligament rupture - Johnson, Victoria L.; Guermazi, Ali; Roemer, Frank; Hunter, David J. (International Journal of Rheumatic Diseases, 2017)
The aim of this study was to examine the difference in the pattern of articular damage in persons with either a partial anterior cruciate ligament (ACL) tear; a complete ACL tear or no ACL tear.Our study included 600 individuals (of the 600 individuals, 25 with a partial, 12 with a complete ACL tear and 563 with no ACL tear) from the progression sub-cohort of the Osteoarthritis Initiative. Individuals had a mean age of 61.8 years (range 45-79 years). Chi-square tests were used to compare the location of meniscal pathology, bone marrow lesions (BMLs) and regional cartilage morphology between individuals with a partial or complete ACL tear, as seen on magnetic resonance imaging, as well as to a control group of 563 knees.Individuals with either a complete or partial ACL tear displayed predominantly medial tibiofemoral damage. Individuals with complete ACL tears were more likely to have cartilage lesions in the lateral posterior tibia (P = 0.03) and the medial anterior femur (P = 0.008) as well as BMLs in the medial posterior tibia (P = 0.007). However, no significant difference in meniscal morphology was found in either compartment. Individuals with no history of knee trauma or ACL injury displayed predominantly medial tibiofemoral compartment damage.Individuals with prevalent ACL disruptions exhibited concomitant osteoarthritic changes in the medial tibiofemoral compartment, as seen on MRI. As the changes in joint tissues were predominantly located in the medial compartment, it is thought that these ACL tears may represent a manifestation of the overall disease process rather than the precipitant for osteoarthritis incidence.
EVALuna2:14695

Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy - Elshafei, Moustafa; Binder, Johannes; Baecker, Justus; Brunner, Maximilian; Uder, Michael; Grützmann, Robert; Krautz, Christian; Weber, Georg (JAMA Surgery, 2019)
Importance: Three-dimensional (3-D) volume rendering has been shown to improve visualization in general surgery. Cinematic rendering (CR), a novel 3-D visualization technology for postprocessing of computed tomographaphy (CT) images, provides photorealistic images with the potential to improve visualization of anatomic details. Objective: To determine the value of CR for the comprehension of the surgical anatomy. Design, Setting, and Participants: This preclinical, randomized, 2-sequence crossover study was conducted from February to November 1, 2018, at University Hospital of Erlangen, Germany. The 40 patient cases were evaluated by 18 resident and attending surgeons using a prepared set of CT and CR images. The patient cases were randomized to 2 assessment sequences (CR-CT and CT-CR). During each assessment period, participants answered 1 question per case that addressed crucial issues of anatomic understanding, preoperative planning, and intraoperative strategies. After a washout period of 2 weeks, case evaluations were crossed over to the respective second image modality. Main Outcomes and Measures: The primary outcome measure was the correctness of answers. Secondary outcome was the time needed to answer. Results: The mean (SD) interperiod differences for the percentage of correct answers in the CR-CT sequence (8.5% [7.0%]) differed significantly from those in the CT-CR sequence (-13.1% [6.3%]) (P <.001). The mean (SD) interperiod differences for the time spent to answer the questions in the CR-CT sequence (-18.3 [76.9] seconds) also differed significantly from those in the CT-CR sequence (52.4 [88.5] seconds) (P <.001). Subgroup analysis revealed that residents as well as attending physicians benefitted from CR visualization. Analysis of the case assessment questionnaire showed that CR added significant value to the comprehension of the surgical anatomy (overall mean [SD] score, 4.53 [0.75]). No carryover or period effects were observed. Conclusions and Relevance: The visualization with CR allowed a more correct and faster comprehension of the surgical anatomy compared with conventional CT imaging, independent of level of surgeon experience. Therefore, CR may assist general surgeons with preoperative preparation and intraoperative guidance..
CRIS-Team Scopus Importer:2019-06-18

Comparison of conventional CTA and volume perfusion CTA in evaluation of cerebral arterial vasculature in acute stroke - Saake, Marc; Gölitz, Philipp; Struffert, Tobias; Breuer, Lorenz; Volbers, Bastian; Dörfler, Arnd; Kloska, Stephan (American Journal of Neuroradiology, 2012)
BACKGROUND AND PURPOSE: CTA-like datasets can be reconstructed from whole-brain VPCTA. The aim of our study was to compare VPCTA with CTA for detection of intracranial stenosis and occlusion in stroke patients. Omitting CTA from stroke CT could reduce radiation dose. MATERIALS AND METHODS: One hundred sixty-three patients were included in this retrospective analysis. Inclusion criterion was suspected stroke within 4.5 hours after onset of symptoms. All examinations were performed on a 128-section multidetector CT scanner. Axial, coronal, and sagittal maximum intensity projections were reconstructed from CTA and from peak arterial phase of VPCTA. Images were scored for quality and presence of intracranial stenosis >50% or occlusion. For statistical analysis, the Wilcoxon signed-rank test and Fisher exact test were used, with a 2-tailed P value of .05 or less for statistical significance. RESULTS: Average image quality was superior in CTA (P < .05). However, image quality dichotomized for diagnostic significance was without difference between CTA and VPCTA (P > .05). Comparative statistical analysis revealed no significant difference for detection of intracranial stenosis and occlusion between CTA and VPCTA (P > .05). Substitution of intracranial CTA by VPCTA would lower radiation dose by 0.5 mSv. CONCLUSIONS: VPCTA is suited to assess the intracranial vasculature in patients with stroke and might have the potential to decrease radiation dose by substituting for intracranial CTA in stroke CT. Additional studies are necessary to further evaluate potential benefits of the dynamic nature of VPCTA.
CRIS-Team Scopus Importer:2022-08-05

Comparison of Diagnostic Performance and Image Quality between Topup-Corrected and Standard Readout-Segmented Echo-Planar Diffusion-Weighted Imaging for Cholesteatoma Diagnostics - Wiesmüller, Marco; Wüst, Wolfgang; Mennecke, Angelika; May, Matthias; Heiß, Rafael; Führes, Tobit; Janka, Rolf Matthias; Uder, Michael; Dörfler, Arnd; Laun, Frederik Bernd (Diagnostics, 2023)
This study compares the diagnostic performance and image quality of single-shot turbo spin-echo DWI (tseDWI), standard readout-segmented DWI (rsDWI), and a modified rsDWI version (topupDWI) for cholesteatoma diagnostics. Thirty-four patients with newly suspected unilateral cholesteatoma were examined on a 1.5 Tesla MRI scanner. Diagnostic performance was evaluated by calculating and comparing the sensitivity and specificity using histopathological results as the standard of reference. Image quality was independently reviewed by two readers using a 5-point Likert scale evaluating image distortions, susceptibility artifacts, image resolution, lesion conspicuity, and diagnostic confidence. Twenty-five cholesteatomas were histologically confirmed after surgery and originated in the study group. TseDWI showed the highest sensitivity with 96% (95% confidence interval (CI): 88–100%), followed by topupDWI with 92% (95% CI: 81–100%) for both readers. The sensitivity for rsDWI was 76% (95% CI: 59–93%) for reader 1 and 84% (95% CI: 70–98%) for reader 2, respectively. Both tseDWI and topupDWI revealed a specificity of 100% (95% CI: 66–100%) and rsDWI of 89% (95% CI: 52–100%). Both tseDWI and topupDWI showed fewer image distortions and susceptibility artifacts compared to rsDWI. Image resolution was consistently rated best for topupDWI, followed by rsDWI, which both outperformed tseDWI. TopupDWI and tseDWI showed comparable results for lesions’ conspicuity and diagnostic confidence, both outperforming rsDWI. Modified readout-segmented DWI using the topup-correction method is preferable to standard rsDWI and may be regarded as an accurate alternative to single-shot turbo spin-echo DWI in cholesteatoma diagnostics.
CRIS-Team Scopus Importer:2023-04-28
Keywords: cholesteatoma; diffusion-weighted imaging; DWI; echo-planar imaging; EPI; readout-segmented; reduced susceptibility-induced distortions; topup correction; TSE; turbo spin-echo

Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study - Podlipska, Jana; Guermazi, Ali; Lehenkari, Petri; Niinimaki, Jaakko; Roemer, Frank; Arokoski, Jari P.; Kaukinen, Paivi; Liukkonen, Esa; Lammentausta, Eveliina; Nieminen, Miika T.; Tervonen, Osmo; Koski, Juhani M.; et al. (Scientific Reports, 2016)
Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level.
EVALuna2:14652

Comparison of dual- and single-source dual-energy CT in head and neck imaging - May, Matthias; Wiesmüller, Marco; Heiß, Rafael; Brand, Michael; Brügel, Joscha; Uder, Michael; Wüst, Wolfgang (European Radiology, 2019)
Objectives: The aim of this study was to compare image quality of single-source dual-energy CT (SS-DECT) with third-generation dual-source dual-energy CT (DS-DECT) in head and neck cancer. Materials and methods: One hundred two patients with histologically proven head and neck cancer were prospectively randomized to undergo radiation dose-matched SS-DECT (n = 51, 120 kV, split-filter technique, 384 ref. mAs) or DS-DECT (n = 51, 80/Sn150 kV, tube A 100/tube B 67 ref. mAs). Inline default images (DI) and virtual monoenergetic images (VMI) for two different low energies (40 and 60 keV) were reconstructed. Objective image quality was evaluated as dose-normalized contrast to noise ratio (CNRD), and subjective image quality was rated on a 5-point Likert scale. Results: In both groups, highest CNRD values for vessel and tumor attenuation were obtained at 40 keV. DS-DECT was significantly better than SS-DECT regarding vessel and tumor attenuation. Overall subjective image quality in the SS-DECT group was highest on the DI followed by 40 keV and 60 keV. In the DS-DECT group, subjective image quality was highest at 40 keV followed by 60 keV and the DI. Forty kiloelectron volts and 60 keV were significantly better in the DS-DECT compared to the SS-DECT group (both p < 0.01). Conclusions: In split-filter SS-DECT as well as in DS-DECT, highest overall image quality in head and neck imaging can be obtained with a combination of DI and low keV reconstructions. DS-DECT is superior to split-filter SS-DECT in terms of subjective image quality and vessel and tumor attenuation. Key Points: • Image quality was diagnostic with both dual-energy techniques; however, the dual-source technique delivered significantly better results. • Highest overall image quality in head and neck imaging can be obtained with a combination of default images and low keV reconstructions with both dual-energy techniques. • The results of this study may have relevance for the decision-making process regarding replacement of CT scanners and focused patient examination considering image quality and subsequent therapeutic decision-making.
CRIS-Team Scopus Importer:2019-07-19
Keywords: Diagnostic imaging; Head and neck neoplasms; Image enhancement

Comparison of evaluation metrics of deep learning for imbalanced imaging data in osteoarthritis studies - Liu, Shen; Roemer, Frank; Ge, Yong; Bedrick, Edward J.; Li, Zong Ming; Guermazi, Ali; Sharma, Leena; Eaton, Charles; Hochberg, Marc C.; Hunter, David J.; Nevitt, Michael C.; Wirth, Wolfgang; et al. (Osteoarthritis and Cartilage, 2023)
Purpose: To compare the evaluation metrics for deep learning methods that were developed using imbalanced imaging data in osteoarthritis studies. Materials and methods: This retrospective study utilized 2996 sagittal intermediate-weighted fat-suppressed knee MRIs with MRI Osteoarthritis Knee Score readings from 2467 participants in the Osteoarthritis Initiative study. We obtained probabilities of the presence of bone marrow lesions (BMLs) from MRIs in the testing dataset at the sub-region (15 sub-regions), compartment, and whole-knee levels based on the trained deep learning models. We compared different evaluation metrics (e.g., receiver operating characteristic (ROC) and precision-recall (PR) curves) in the testing dataset with various class ratios (presence of BMLs vs. absence of BMLs) at these three data levels to assess the model's performance. Results: In a subregion with an extremely high imbalance ratio, the model achieved a ROC-AUC of 0.84, a PR-AUC of 0.10, a sensitivity of 0, and a specificity of 1. Conclusion: The commonly used ROC curve is not sufficiently informative, especially in the case of imbalanced data. We provide the following practical suggestions based on our data analysis: 1) ROC-AUC is recommended for balanced data, 2) PR-AUC should be used for moderately imbalanced data (i.e., when the proportion of the minor class is above 5% and less than 50%), and 3) for severely imbalanced data (i.e., when the proportion of the minor class is below 5%), it is not practical to apply a deep learning model, even with the application of techniques addressing imbalanced data issues.
CRIS-Team Scopus Importer:2023-06-16
Keywords: Bone marrow lesion; Deep learning; Imbalanced data; Osteoarthritis; Precision recall curve; Receiver operating characteristic

Comparison of Intracranial Aneurysms Treated by 2-D Versus 3-D Coils: A Matched-Pairs Analysis - Lang, Stefan; Rösch, Julie; Gölitz, Philipp; Kloska, Stephan; Struffert, Tobias; Dörfler, Arnd (Clinical Neuroradiology, 2017)
OBJECTIVE: Knowledge on the influence of 2D and 3D coils to occlude intracranial aneurysms is poor. Therefore, aim of our analysis was to evaluate whether the use of 3-D versus 2-D coils alone may improve the efficacy of endovascular aneurysm treatment. PATIENTS AND METHODS: We performed a matched pair analysis comparing aneurysms treated by 3-D coils as initial "framing" coils to aneurysms treated exclusively by 2-D coils. Number of coils, implanted coil length/volume, and associated packing density were calculated. Aneurysmal occlusion was assessed and monitored 6 months (DSA; magnetic resonance angiography (MRA)) and 18 months (MRA) after embolization. Periprocedural complications and retreatment rate of each group were analyzed. RESULTS: Our retrospective analysis revealed 50 pairs. Concerning the 3-D group, number of coils (353 in total, median 7; p = 0.002), implanted coil length (55.69 ± 48.4 cm), implanted coil length per volume (5.92 mm/mm3), and packing density (30 %; p = 0.017) was higher than in the 2-D group (259 in total, median 5 coils; 38.52 ± 43.13 cm; 4.54 mm/mm3; 23 %). Occlusion was not significantly different immediately after treatment but at 6 and 18 months follow-up in favor of 3-D coils. Retreatment was performed in 2 cases of the 3-D group and in 3 cases of the 2-D group and therefore in a similar range (p = 0.564). CONCLUSION: Initial use of 3-D coils revealed a higher packing density and a higher long-term occlusion. Therefore, we recommend initial use of 3-D coils.
EVALuna2:33475

Comparison of optimized intensity correction methods for 23Na MRI of the human brain using a 32-channel phased array coil at 7 Tesla - Lachner, Sebastian; Ruck, Laurent; Niesporek, Sebastian C.; Utzschneider, Matthias; Lott, Johanna; Hensel, Bernhard; Dörfler, Arnd; Uder, Michael; Nagel, Armin Michael (Zeitschrift für Medizinische Physik, 2019)
Purpose: To correct for the non-homogeneous receive profile of a phased array head coil in sodium magnetic resonance imaging (23Na MRI). Methods: 23Na MRI of the human brain (n = 8) was conducted on a 7T MR system using a dual-tuned quadrature 1H/23Na transmit/receive birdcage coil, equipped with a 32-channel receive-only array. To correct the inhomogeneous receive profile four different methods were applied: (1) the uncorrected phased array image and an additionally acquired birdcage image as reference image were low-pass filtered and divided by each other. (2) The second method substituted the reference image by a support region. (3) By averaging the individually calculated receive profiles, a universal sensitivity map was obtained and applied. (4) The receive profile was determined by a pre-scanned large uniform phantom. The calculation of the sensitivity maps was optimized in a simulation study using the normalized root-mean-square error (NRMSE). All methods were evaluated in phantom measurements and finally applied to in vivo 23Na MRI data sets. The in vivo measurements were partial volume corrected and for further evaluation the signal ratio between the outer and inner cerebrospinal fluid compartments (CSFout:CSFin) was calculated. Results: Phantom measurements show the correction of the intensity profile applying the given methods. Compared to the uncorrected phased array image (NRMSE = 0.46, CSFout:CSFin = 1.71), the quantitative evaluation of simulated and measured intensity corrected human brain data sets indicates the best performance utilizing the birdcage image (NRMSE = 0.39, CSFout:CSFin = 1.00). However, employing a support region (NRMSE = 0.40, CSFout:CSFin = 1.17), a universal sensitivity map (NRMSE = 0.41, CSFout:CSFin = 1.05) or a pre-scanned sensitivity map (NRMSE = 0.42, CSFout:CSFin = 1.07) shows only slightly worse results. Conclusion: Acquiring a birdcage image as reference image to correct for the receive profile demonstrates the best performance. However, when aiming to reduce acquisition time or for measurements without existing birdcage coil, methods that use a support region as reference image, a universal or a pre-scanned sensitivity map provide good alternatives for correction of the receive profile.
CRIS-Team Scopus Importer:2019-12-31
Keywords: 7 Tesla; Intensity correction; Multi-channel array coil; Phased array coil; Receive profile; Sodium MRI

Comparison of ped and fred flow diverters for posterior circulation aneurysms: a propensity score matched cohort study - Griessenauer, Christoph J.; Enriquez-Marulanda, Alejandro; Xiang, Sissi; Hong, Tao; Zhang, Hongqi; Taussky, Philipp; Grandhi, Ramesh; Waqas, Muhammad; Tutino, Vincent M.; Siddiqui, Adnan H.; Levy, Elad I.; Ogilvy, Christopher S.; et al. (Journal of Neurointerventional Surgery, 2020)
Background: Flow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce. Objective: To perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms. Methods: Consecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome. Results: A total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2%) and FRED in 84 (22.8%) procedures. Aneurysms treated with the PED were more commonly fusiform and larger than those treated with FRED. To account for these important differences, propensity score matching was performed resulting in 33 PED and FRED unruptured aneurysm pairs. No differences were found in occlusion status and neurologic thromboembolic or hemorrhagic complications between the two devices. The proportion of patients with favorable functional outcome was higher with FRED (100% vs 87.9%, p=0.04). Conclusion: Comparative analysis of PED and FRED for the treatment of unruptured posterior circulation aneurysms did not identify significant differences in aneurysm occlusion or neurologic complications. Variations in functional outcomes warrant additional investigations.
CRIS-Team Scopus Importer:2020-07-31
Keywords: Aneurysm; Embolic; Flow diverter; Intervention; Posterior fossa

Comparison of performance between rigid and non-rigid software registering CT to FDG-PET - Wolz, Gabriele; Nömayr, Anton; Hothorn, Torsten; Hornegger, Joachim; Römer, Wolfgang; Bautz, Werner; Kuwert, Torsten (International Journal of Computer Assisted Radiology and Surgery, 2007)
Object: This retrospective study compares the anatomical accuracy of automated rigid and non-rigid registration software for aligning data from separately performed X-ray computed tomography (CT) and positron emission tomography with F-18-deoxyglucose (PET). Materials and methods: Analyses were performed on independently acquired PET and CT data from 40 tumor patients. Rigid as well as non-rigid automated fusion was carried out using the commercially available Mirada 7D platform (MIR and MINR, respectively) as well as a second automated non-rigid registration based on a variational image registration approach (VIR). Distances between lesion representation on PET and CT of 105 malignant lesions were measured in X-, Y-, and Z-directions. Statistical evaluation was performed using mixed effect analysis, comparing separately MIR with MINR and VIR with MINR. Results: The percentage of lesions misregistered by less than 15 mm varied from 70% for MIR and MINR in Z-direction to 93% for VIR in X-direction. The average X-, Y- and Z-distances ranged between 5.9 ± 5.7 mm for VIR in X-direction and 12.8 ± 9.7 mm for MIR in Z-direction. MINR was significantly more accurate than MIR in Y-direction. Furthermore, VIR aligned thoracic lesions in the X- direction significantly better than MINR. Conclusion: The accuracy of rigid and non-rigid automated image registration can be expected to be better than 15 mm for the majority of lesions. Alignment tended to be more accurate with non-rigid registration. © CARS 2007.

Comparison of Pipeline Embolization Device and Flow Re-Direction Endoluminal Device Flow Diverters for Internal Carotid Artery Aneurysms: A Propensity Score-Matched Cohort Study - Griessenauer, Christoph J.; Thomas, Ajith J.; Enriquez-Marulanda, Alejandro; Deshmukh, Aviraj; Jain, Abhi; Ogilvy, Christopher S.; Kocer, Naci; Engelhorn, Tobias; Möhlenbruch, Markus; Holtmannspötter, Markus; Janssen, Hendrik; Finkenzeller, Thomas; et al. (Neurosurgery, 2019)
BACKGROUND: Flow diversion has become an accepted endovascular treatment modality for intracranial aneurysms. Studies comparing different types of flow diverters are currently lacking. OBJECTIVE: To perform a propensity score-matched cohort study comparing the Pipeline Embolization Device (PED; Medtronic, Dublin, Ireland) and Flow Redirection Endoluminal Device (FRED; MicroVention, Aliso Viejo, California). METHODS: Aneurysms of the internal carotid artery proximal to the communicating segment treated with PED at 2 neurovascular centers in the United States were matched with aneurysms treated in the European FRED study using propensity scoring. Aneurysms treated in the setting of subarachnoid hemorrhage were excluded from matching. Occlusion rates and complications were evaluated. RESULTS: Two hundred twenty-one internal carotid artery aneurysms were treated with PED and 282 with FRED. Propensity score matching controlling for age, sex, aneurysm size, location, number of flow diverters, and adjunctive coiling resulted in 55 matched pairs. Median angiographic follow-up was nonsignificantly longer for FRED compared to PED (12.2 vs 7.5 mo, P = .28). The rate of complete occlusion did not differ between flow diverters (80% vs 80%, P > .99). Functional outcome and complications were comparable for PED and FRED. CONCLUSION: Propensity score-matched analysis of PED and FRED for internal carotid artery aneurysms revealed comparable angiographic complete occlusion and complication rates. Whether FRED has an advantage in terms of near complete aneurysm occlusion warrants further investigation. Limitations include the retrospective design and lack of an independent assessment of radiographic outcome in a core-laboratory and functional outcomes, among others, and the results should be interpreted as such.
CRIS-Team Scopus Importer:2019-08-06
Keywords: Aneurysm; Embolization; Flow diversion; Stent

Comparison of potassium and sodium binding in vivo and in agarose samples using TQTPPI pulse sequence - Schepkin, Victor D.; Neubauer, Andreas; Nagel, Armin Michael; Budinger, Thomas F. (Journal of Magnetic Resonance, 2017)
Potassium and sodium specific binding in vivo were explored at 21.1T by triple quantum (TQ) magnetic resonance (MR) signals without filtration to achieve high sensitivities and precise quantifications. The pulse sequence used time proportional phase increments (TPPI). During simultaneous phase-time increments, it provided total single quantum (SQ) and TQ MR signals in the second dimension at single and triple quantum frequencies, respectively. The detection of both TQ and SQ signals was performed at identical experimental conditions and the resulting TQ signal equals 60±3% of the SQ signal when all ions experience sufficient time for binding. In a rat head in vivo the TQ percentage relative to SQ for potassium is 41.5±3% and for sodium is 16.1±1%. These percentages were compared to the matching values in an agarose tissue model with MR relaxation times similar to those of mammalian brain tissue. The sodium TQ signal in agarose samples decreased in the presence of potassium, suggesting a competitive binding of potassium relative to sodium ions for the same binding sites. The TQTPPI signals correspond to almost two times more effective binding of potassium than sodium. In vivo, up to 69% of total potassium and 27% of total sodium can be regarded as bound or experiencing an association time in the range of several milliseconds. Experimental data analyses show that more than half of the in vivo total sodium TQ signal could be from extracellular space, which is an important factor for quantification of intracellular MR signals.
EVALuna2:14663

Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative - Eckstein, Felix; Boudreau, Robert; Wang, Zhijie; Hannon, Michael J.; Duryea, Jeff; Wirth, Wolfgang; Cotofana, Sebastian; Guermazi, Ali; Roemer, Frank; Nevitt, Michael; John, Markus R.; Ladel, Christoph; et al. (European Radiology, 2016)
To evaluate whether change in fixed-location measures of radiographic joint space width (JSW) and cartilage thickness by MRI predict knee replacement.Knees replaced between 36 and 60 months' follow-up in the Osteoarthritis Initiative were each matched with one control by age, sex and radiographic status. Radiographic JSW was determined from fixed flexion radiographs and subregional femorotibial cartilage thickness from 3 T MRI. Changes between the annual visit before replacement (T0) and 2 years before T0 (T-2) were compared using conditional logistic regression.One hundred and nineteen knees from 102 participants (55.5 % women; age 64.2 ± 8.7 [mean ± SD] years) were studied. Fixed-location JSW change at 22.5 % from medial to lateral differed more between replaced and control knees (case-control [cc] OR = 1.57; 95 % CI: 1.23-2.01) than minimum medial JSW change (ccOR = 1.38; 95 % CI: 1.11-1.71). Medial femorotibial cartilage loss displayed discrimination similar to minimum JSW, and central tibial cartilage loss similar to fixed-location JSW. Location-independent thinning and thickening scores were elevated prior to knee replacement.Discrimination of structural progression between knee pre-placement cases versus controls was stronger for fixed-location than minimum radiographic JSW. MRI displayed similar discrimination to radiography and suggested greater simultaneous cartilage thickening and loss prior to knee replacement.o Fixed-location JSW predicts surgical knee replacement more strongly than minimum JSW. o MRI predicts knee replacement with similar accuracy to radiographic JSW. o MRI reveals greater cartilage thinning and thickening prior to knee replacement.
EVALuna2:14667

COMPARISON OF RADIOGRAPHY, 3T AND 7T MAGNETIC RESONANCE IMAGING FOR ANALYSIS OF DISTAL RADIUS TRABECULAR BONE IN PATIENTS WITH ESTABLISHED OR SUSPECTED WRIST OSTEOARTHRITIS USING FRACTAL SIGNATURE ANALYSIS - Jarraya, M.; Heiß, Rafael; Duryea, J.; Lynch, J.; Weber, M. -A.; Guermazi, A.; Uder, Michael; Roemer, Frank (OSTEOARTHRITIS AND CARTILAGE, 2020)
CRIS-Team WoS Importer:2020-06-02

Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics - Wiesmüller, Marco; Wüst, Wolfgang; May, Matthias; Ellmann, Stephan; Heiß, Rafael; Saake, Marc; Janka, Rolf Matthias; Uder, Michael; Laun, Frederik Bernd (American Journal of Neuroradiology, 2021)
BACKGROUND AND PURPOSE: The high diagnostic value of DWI for cholesteatoma diagnostics is undisputed. This study compares the diagnostic value of readout-segmented echo-planar DWI and single-shot TSE DWI for cholesteatoma diagnostics.
CRIS-Team WoS Importer:2021-06-04

Comparison of Sonography versus Digital Breast Tomosynthesis to Locate Intramammary Marker Clips - Schulz-Wendtland, Rüdiger; Dankerl, Peter; Dilbat, G.; Bani, Mayada; Fasching, Peter; Heusinger, K.; Lux, Michael P.; Löhberg, Christian; Jud, Sebastian; Rauh, C.; Bayer, C. M.; Beckmann, Matthias; et al. (Geburtshilfe und Frauenheilkunde, 2015)
Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve the accuracy when locating intramammary marker clips compared to sonography and could, in future, be used to complement or even completely replace sonography.
EVALuna2:6724

Comparison of Two Automated Computed Tomography Perfusion Applications to Predict the Final Infarct Volume After Thrombolysis in Cerebral Infarction 3 Recanalization - Mühlen, Iris; Sprügel, Maximilian; Hölter, Philip; Hock, Stefan; Knott, Michael; Huttner, Hagen; Schwab, Stefan; Kallmünzer, Bernd; Dörfler, Arnd (Stroke, 2022)
Background: Several automated computed tomography perfusion software applications have been developed to provide support in the definition of ischemic core and penumbra in acute ischemic stroke. However, the degree of interchangeability between software packages is not yet clear. Our study aimed to evaluate 2 commonly used automated perfusion software applications (Syngo.via and RAPID) for the indication of ischemic core with respect to the follow-up infarct volume (FIV) after successful recanalization and with consideration of the clinical impact. Methods: Retrospectively, 154 patients with large vessel occlusion of the middle cerebral artery or the internal carotid artery, who underwent endovascular therapy with a consequent Thrombolysis in Cerebral Infarction 3 result within 2 hours after computed tomography perfusion, were included. Computed tomography perfusion core volumes were assessed with both software applications with different thresholds for relative cerebral blood flow (rCBF). The results were compared with the FIV on computed tomography within 24 to 36 hours after recanalization. Bland-Altman was applied to display the levels of agreement and to evaluate systematic differences. Results: Highest correlation between ischemic core volume and FIV without significant differences was found at a threshold of rCBF<38% for the RAPID software (r=0.89, P<0.001) and rCBF<25% for the Syngo software (r=0.87, P<0.001). Bland-Altman analysis revealed best agreement in these settings. In the vendor default settings (rCBF<30% for RAPID and rCBF<20% for Syngo) correlation between ischemic core volume and FIV was also high (RAPID: r=0.88, Syngo: r=0.86, P<0.001), but mean differences were significant (P<0.001). The risk of critical overestimation of the FIV was higher with rCBF<38% (RAPID) and rCBF<25% (Syngo) than in the default settings. Conclusions: By adjusting the rCBF thresholds, comparable results with reliable information on the FIV after complete recanalization can be obtained both with the RAPID and Syngo software. Keeping the software specific default settings means being more inclusive in patient selection, but forgo the highest possible accuracy in the estimation of the FIV.
CRIS-Team WoS Importer:2022-05-13

Comparison of vestibular schwannoma visualization between 0.55 T and 1.5 T MRI - Wiesmüller, Marco; Kopp, Markus; Sievert, Matti; May, Matthias; Nagel, Armin Michael; Iro, Heinrich; Uder, Michael; Heiß, Rafael (European Journal of Radiology, 2023)
Objectives: Vestibular schwannoma (VS) is the most common mass of the internal auditory canal (IAC) and is responsible for unilateral sensorineural hearing loss. Magnetic resonance imaging (MRI) at 1.5 T and 3 T is the standard of care for the evaluation of VS, and the feasibility of using modern low-field MRI for imaging of the IAC has not yet been elucidated. Hence, the purpose of this prospective study was to assess image quality and diagnostic performance of a modern 0.55 T MRI. Materials and Methods: Fifty-six patients with known unilateral VS underwent routine MRI of the IAC at 1.5 T, followed immediately by 0.55 T MRI. Two radiologists independently evaluated the image quality, conspicuity of VS, diagnostic confidence, and image artifacts separately for isotropic T2-weighted SPACE images and for transversal and coronal T1-weighted fat-saturated contrast-enhanced images at 1.5 T and 0.55 T using 5-point Likert scales. In a second independent reading, both readers assessed lesion conspicuity and subjective diagnostic confidence in a direct comparison of 1.5 T and 0.55 T images. Results: Image quality of transversal T1-weighted images (p = 0.13 and p = 0.16 for Reader 1 and Reader 2, respectively) and T2-weighted SPACE images (p = 0.39 and p = 0.58) were rated equally at 1.5 T and 0.55 T by both readers, whereas image quality of coronal T1-weighted images was superior at 1.5 T (p = 0.009 and p = 0.001). Analysis of the conspicuity of VS, diagnostic confidence, and image artifacts of all sequences revealed no significant differences between 1.5 T and 0.55 T. In the direct comparison of 1.5 T with 0.55 T images, there were no significant differences in lesion conspicuity or diagnostic confidence for any sequence (p = 0.60–0.73). Conclusions: Modern low-field MRI at 0.55 T provided a sufficient diagnostic image quality and seems feasible for the evaluation of VS of the IAC.
CRIS-Team Scopus Importer:2023-07-28
Keywords: 0.55T MRI; Acoustic neuroma; Image quality; Inner auditory canal; low-field MRI; Vestibular schwannoma

Compensation of concomitant field effects in double diffusion encoding by means of added oscillating gradients - Rauch, Julian; Laun, Frederik Bernd; Bachert, Peter; Ladd, Mark E.; Kuder, Tristan A. (Magnetic Resonance Imaging, 2024)
Maxwell or concomitant fields imprint additional phases on the transverse magnetization. This concomitant phase may cause severe image artifacts like signal voids or distort the quantitative parameters due to the induced intravoxel dephasing. In particular, double diffusion encoding (DDE) schemes with two pairs of bipolar diffusion-weighting gradients separated by a refocusing radiofrequency (RF) pulse are prone to concomitant field-induced artifacts. In this work, a method for reducing concomitant field effects in these DDE sequences based on additional oscillating gradients is presented. These oscillating gradient pulses obtained by constrained optimization were added to the original gradient waveforms. The modified sequences reduced the accumulated concomitant phase without significant changes in the original sequence characteristics. The proposed method was applied to a DDE acquisition scheme consisting of 60 pairs of diffusion wave vectors. For phantom as well as for in vivo experiments, a considerable increase in the signal-to-noise ratio (SNR) was obtained. For phantom measurements with a diffusion weighting of b = 2000 s/mm2 for each of the gradient pairs, an SNR increase of up to 40% was observed for a transversal slice that had a distance of 5 cm from the isocenter. For equivalent slice parameters, in vivo measurements in the brain of a healthy volunteer exhibited an increase in SNR of up to 35% for b = 750 s/mm2 for each weighting. These findings are supported by corresponding simulations, which also predict a positive effect on the SNR. In summary, the presented method leads to an SNR gain without additional RF refocusing pulses.
CRIS-Team Scopus Importer:2023-12-15
Keywords: Concomitant fields; Diffusion weighting; Double diffusion encoding; Optimization; Oscillating gradients; Sequence design

Complete Free-breathing Adenosine Stress Cardiac MRI Using Compressed Sensing and Motion Correction: Comparison of Functional Parameters, Perfusion, and Late Enhancement with the Standard Breath-holding Examination. - Treutlein, Christoph; Wiesmüller, Marco; May, Matthias; Heiß, Rafael; Hepp, Tobias; Uder, Michael; Wüst, Wolfgang (Radiology: Cardiothoracic Imaging, 2019)
Purpose: To compare free-breathing (FB) stress cardiac MRI examinations with the reference standard breath-holding (BH) examination. Materials and Methods: A total of 40 consecutive patients were enrolled prospectively and were examined with 3-T MRI. Functional imaging, perfusion, and late gadolinium enhancement (LGE) sequences were performed in BH and FB by using compressed sensing and in-line motion correction. Left ventricle (LV) and right ventricle (RV) functional parameters in BH and FB examinations were compared by using Bland-Altman plots and linear mixed models. Subjective image quality was assessed with a five-point scale (1 = nondiagnostic, 5 = very good). For perfusion and LGE imaging, diagnostic confidence was rated with a three-point scale (1 = low, 3 = high), and image quality was rated with a five-point scale (1 = nondiagnostic, 5 = very good). The Wilcoxon test was used to compare image quality and diagnostic confidence. Results: Bland-Altman plots showed good agreement for LV and RV functional parameters in BH and FB sequences. Subjective image quality was significantly better with the BH sequences in the LV (P < .01) but was comparable in the RV (P > .99). Scanning time was 218 seconds (range, 130-385 seconds) for cine BH and 16 seconds (range, 11-27 seconds) for cine FB. Extent of perfusion defects, LGE, and diagnostic confidence was comparable between groups. Scanning time was 371 seconds (range, 239-502 seconds) for the LGE BH sequence and 189 seconds (range, 122-286 seconds) for the LGE FB sequence. Conclusion: FB adenosine stress cardiac MRI delivers diagnostic image quality and could represent an alternative for use in patients who are unable to meet the demands of multiple BHs and long examination times.© RSNA, 2019.
EVALuna2:469014

Compositional changes predict morphologic cartilage lesion development - are we one step closer to clinical translation of quantitative MRI? - Li, X.; Roemer, Frank (Osteoarthritis and Cartilage, 2019)
CRIS-Team WoS Importer:2019-05-03

Compositional Magnetic Resonance Imaging Measures of Cartilage - Endpoints for Clinical Trials of Disease-modifying Osteoarthritis Drugs? - Guermazi, Ali; Crema, Michel D.; Roemer, Frank (Journal of Rheumatology, 2016)
EVALuna2:14536

Compositional MRI assessment of cartilage: what is it and what is its potential for sports medicine? - Guermazi, Ali; Roemer, Frank (British Journal of Sports Medicine, 2016)
EVALuna2:14665

Compositional MRI techniques for evaluation of cartilage degeneration in osteoarthritis - Guermazi, A.; Alizai, H.; Crema, M. D.; Trattnig, S.; Regatte, R. R.; Roemer, Frank (Osteoarthritis and Cartilage, 2015)
Osteoarthritis (OA), a leading cause of disability, affects 27 million people in the United States and its prevalence is rising along with the rise in obesity. So far, biomechanical or behavioral interventions as well as attempts to develop disease-modifying OA drugs have been unsuccessful. This may be partly due to antiquated imaging outcome measures such as radiography, which are still endorsed by regulatory agencies such as the United States Food and Drug Administration (FDA) for use in clinical trials. Morphological magnetic resonance imaging (MRI) allows unparalleled multi-feature assessment of the OA joint. Furthermore, advanced MRI techniques also enable evaluation of the biochemical or ultrastructural composition of articular cartilage relevant to OA research. These compositional MRI techniques have the potential to supplement clinical MRI sequences in identifying cartilage degeneration at an earlier stage than is possible today using morphologic sequences only. The purpose of this narrative review is to describe compositional MRI techniques for cartilage evaluation, which include T2 mapping, T2* Mapping, T1 rho, dGEMRIC, gagCEST, sodium imaging and diffusion weighted imaging (DWI). We also reviewed relevant clinical studies that have utilized these techniques for the study of OA. The different techniques are complementary. Some focus on isotropy or the collagen network (e.g., T2 mapping) and others are more specific in regard to tissue composition, e.g., gagCEST or dGEMRIC that convey information on the GAG concentration. The application and feasibility of these techniques is also discussed, as they will play an important role in implementation in larger clinical trials and eventually clinical practice.
EVALuna2:14534

Compound heterozygous RYR1 mutations in a preterm with arthrogryposis multiplex congenita and prenatal CNS bleeding - Brackmann, Florian; Türk, Matthias; Gratzki, Nils; Rompel, Oliver; Jungbluth, Heinz; Schröder, Rolf; Trollmann, Regina (Neuromuscular Disorders, 2018)
RYR1 mutations, the most common cause of non-dystrophic neuromuscular disorders, are associated with the malignant hyperthermia susceptibility (MHS) trait as well as congenital myopathies with widely variable clinical and histopathological manifestations. Recently, bleeding anomalies have been reported in association with certain RYR1 mutations. Here we report a preterm infant born at 32 weeks gestation with arthrogryposis multiplex congenita due to compound heterozygous, previously MHS-associated RYR1 mutations, with additional signs of prenatal hemorrhage. The patient presented at birth with multiple joint contractures, scoliosis, severe thoracic rigidity and respiratory failure. He continued to depend on mechanical ventilation and tube feeding. Muscle histopathology showed a marked myopathic pattern with eccentric cores. Interestingly, the patient had additional unusual prenatal intraventricular hemorrhage, resulting in post-hemorrhagic hydrocephalus as well as epidural hemorrhage affecting the spinal cord. This report adds to the phenotypic variability associated with RYR1 mutations, and highlights possible bleeding complications in affected individuals.
EVALuna2:34599

Comprehensive 7 T CEST: A clinical MRI protocol covering multiple exchange rate regimes - Fabian, Moritz; Rajput, Junaid Rasool; Schüre, Jan-Rüdiger; Weinmüller, Simon; Mennecke, Angelika; Möhle, Tim Alexius; Rampp, Stefan; Schmidt, Manuel; Dörfler, Arnd; Zaiß, Moritz (NMR in Biomedicine, 2024)
SECTIONSPDFPDFTOOLS SHARE Abstract Chemical exchange saturation transfer (CEST) is a magnetic resonance (MR) imaging method providing molecular image contrasts based on indirect detection of low concentrated solutes. Previous CEST studies focused predominantly on the imaging of single CEST exchange regimes (e.g., slow, intermediate or fast exchanging groups). In this work, we aim to establish a so-called comprehensive CEST protocol for 7 T, covering the different exchange regimes by three saturation B1 amplitude regimes: low, intermediate and high. We used the results of previous publications and our own simulations in pulseq-CEST to produce a 7 T CEST protocol that has sensitivity to these three B1 regimes. With postprocessing optimization (simultaneous mapping of water shift and B1, B0-fitting, multiple interleaved mode saturation B1 correction, neural network employment (deepCEST) and analytical input feature reduction), we are able to shorten our initially 40 min protocol to 15 min and generate six CEST contrast maps simultaneously. With this protocol, we measured four healthy subjects and one patient with a brain tumor. We established a comprehensive CEST protocol for clinical 7 T MRI, covering three different B1 amplitude regimes. We were able to reduce the acquisition time significantly by more than 50%, while still maintaining decent image quality and contrast in healthy subjects and one patient with a tumor. Our protocol paves the way to perform comprehensive CEST studies in clinical scan times for hypothesis generation regarding molecular properties of certain pathologies, for example, ischemic stroke or high-grade brain tumour

Comprehensive assessment of knee joint synovitis at 7 T MRI using contrast-enhanced and non-enhanced sequences - Treutlein, Christoph; Bäuerle, Tobias; Nagel, Armin Michael; Guermazi, Ali; Kleyer, Arnd; Simon, David; Schett, Georg; Hepp, Tobias; Uder, Michael; Roemer, Frank (BMC Musculoskeletal Disorders, 2020)
BACKGROUND: Seven T ultra-high field MRI systems have recently been approved for clinical use by the U.S. and European regulatory agencies. These systems are now being used clinically and will likely be more widely available in the near future. One of the applications of 7 T systems is musculoskeletal disease and particularly peripheral arthritis imaging. Since the introduction of potent anti-rheumatic therapies over the last two decades MRI has gained increasing importance particularly for assessment of disease activity in early stages of several rheumatic disorders. Commonly gadolinium-based contrast agents are used for assessment of synovitis. Due to potential side-effects of gadolinium non-enhanced techniques are desirable that enable visualization of inflammatory disease manifestations. The feasibility of 7 T MRI for evaluation of peripheral arthritis has not been shown up to now. Aim of our study was to evaluate the feasibility of contrast-enhanced (CE) and non-enhanced MRI at 7 T for the assessment of knee joint synovitis. METHOD: Seven T MRI was acquired for 10 patients with an established diagnosis of psoriatic or rheumatoid arthritis. The study pulse sequence protocol was comprised of a sagittal intermediate-weighted fat-suppressed (FS), axial fluid-attenuated inversion recovery (FLAIR) FS, sagittal 3D T1-weighted dynamic contrast enhanced (DCE) and an axial static 2D T1-weighted FS contrast-enhanced sequence (T1-FS CE). Ordinal scoring on non-enhanced (Hoffa- and effusion-synovitis) and enhanced MRI (11-point synovitis score), and comparison of FLAIR-FS with static T1-FS CE MRI using semiquantitative (SQ) grading and volume assessment was performed. For inter- and intra-reader reliability assessment weighted kappa statistics for ordinal scores and intraclass correlation coefficients (ICC) for continuous variables were used. RESULTS: The total length of study protocol was 15 min 38 s. Different amounts of synovitis were observed in all patients (mild: n = 3; moderate: n = 5; severe: n = 2). Consistently, SQ assessment yielded significantly lower peripatellar summed synovitis scores for the FLAIR-FS sequence compared to the CE T1-FS sequence (p < 0.01). FLAIR-FS showed significantly lower peripatellar synovial volumes (p < 0.01) compared to CE T1-FS imaging with an average percentage difference of 18.6 ± 9.5%. Inter- and intra-reader reliability for ordinal SQ scoring ranged from 0.21 (inter-reader Hoffa-synovitis) to 1.00 (inter-reader effusion-synovitis). Inter- and intra-observer reliability of SQ 3D-DCE parameters ranged from 0.86 to 0.99. CONCLUSIONS: Seven T FLAIR-FS ultra-high field MRI is a potential non-enhanced imaging method able to visualize synovial inflammation with high conspicuity and holds promise for further application in research endeavors and clinical routine by trained readers.
EVALuna2:212706

Comprehensive phenotyping revealed transient startle response reduction and histopathological gadolinium localization to perineuronal nets after gadodiamide administration in rats - Habermeyer, Johanna; Boyken, Janina; Harrer, Julia; Canneva, Fabio; Ratz, Veronika; Moceri, Sandra; Admard, Jakob; Casadei, Nicolas; Jost, Gregor; Bäuerle, Tobias; Frenzel, Thomas; Schmitz, Christoph; et al. (Scientific Reports, 2020)
Gadolinium based contrast agents (GBCAs) are widely used in clinical MRI since the mid-1980s. Recently, concerns have been raised that trace amounts of Gadolinium (Gd), detected in brains even long time after GBCA application, may cause yet unrecognized clinical consequences. We therefore assessed the behavioral phenotype, neuro-histopathology, and Gd localization after repeated administration of linear (gadodiamide) or macrocyclic (gadobutrol) GBCA in rats. While most behavioral tests revealed no difference between treatment groups, we observed a transient and reversible decrease of the startle reflex after gadodiamide application. Residual Gd in the lateral cerebellar nucleus was neither associated with a general gene expression pathway deregulation nor with neuronal cell loss, but in gadodiamide-treated rats Gd was associated with the perineuronal net protein aggrecan and segregated to high molecular weight fractions. Our behavioral finding together with Gd distribution and speciation support a substance class difference for Gd presence in the brain after GBCA application.
CRIS-Team WoS Importer:2021-01-22

Compressed sensing and the use of phased array coils in 23Na MRI: a comparison of a SENSE-based and an individually combined multi-channel reconstruction - Lachner, Sebastian; Utzschneider, Matthias; Zaric, Olgica; Minarikova, Lenka; Ruck, Laurent; Zbýň, Štefan; Hensel, Bernhard; Trattnig, Siegfried; Uder, Michael; Nagel, Armin Michael (Zeitschrift für Medizinische Physik, 2020)
Purpose: To implement and to evaluate a compressed sensing (CS) reconstruction algorithm based on the sensitivity encoding (SENSE) combination scheme (CS-SENSE), used to reconstruct sodium magnetic resonance imaging (23Na MRI) multi-channel breast data sets. Methods: In a simulation study, the CS-SENSE algorithm was tested and optimized by evaluating the structural similarity (SSIM) and the normalized root-mean-square error (NRMSE) for different regularizations and different undersampling factors (USF = 1.8/3.6/7.2/14.4). Subsequently, the algorithm was applied to data from in vivo measurements of the healthy female breast (n = 3) acquired at 7 T. Moreover, the proposed CS-SENSE algorithm was compared to a previously published CS algorithm (CS-IND). Results: The CS-SENSE reconstruction leads to an increased image quality for all undersampling factors and employed regularizations. Especially if a simple 2nd order total variation is chosen as sparsity transformation, the CS-SENSE reconstruction increases the image quality of highly undersampled data sets (CS-SENSE: SSIMUSF=7.2 = 0.234, NRMSEUSF=7.2 = 0.491 vs. CS-IND: SSIMUSF=7.2 = 0.201, NRMSEUSF=7.2 = 0.506). Conclusion: The CS-SENSE reconstruction supersedes the need of CS weighting factors for each channel as well as a method to combine single channel data. The CS-SENSE algorithm can be used to reconstruct undersampled data sets with increased image quality. This can be exploited to reduce total acquisition times in 23Na MRI.
CRIS-Team Scopus Importer:2020-11-20
Keywords: Compressed sensing; Iterative reconstruction; Multi-channel; Prior knowledge; Sensitivity encoding; Sodium MRI

Compressed sensing reconstruction of 7 Tesla23Na multi-channel breast data using 1H MRI constraint - Lachner, Sebastian; Zaric, Olgica; Utzschneider, Matthias; Minarikova, Lenka; Zbýň, Štefan; Hensel, Bernhard; Trattnig, Siegfried; Uder, Michael; Nagel, Armin Michael (Magnetic Resonance Imaging, 2019)
Purpose: To reduce acquisition time and to improve image quality in sodium magnetic resonance imaging ( 23 Na MRI)using an iterative reconstruction algorithm for multi-channel data sets based on compressed sensing (CS)with anatomical 1 H prior knowledge. Methods: An iterative reconstruction for 23 Na MRI with multi-channel receiver coils is presented. Based on CS it utilizes a second order total variation (TV (2) ), adopted by anatomical weighting factors (AnaWeTV (2) )obtained from a high-resolution 1 H image. A support region is included as additional regularization. Simulated and measured 23 Na multi-channel data sets (n = 3)of the female breast acquired at 7 T with different undersampling factors (USF = 1.8/3.6/7.2/14.4)were reconstructed and compared to a conventional gridding reconstruction. The structural similarity was used to assess image quality of the reconstructed simulated data sets and to optimize the weighting factors for the CS reconstruction. Results: Compared with a conventional TV (2) , the AnaWeTV (2) reconstruction leads to an improved image quality due to preserving of known structure and reduced partial volume effects. An additional incorporated support region shows further improvements for high USFs. Since the decrease in image quality with higher USFs is less pronounced compared to a conventional gridding reconstruction, proposed algorithm is beneficial especially for higher USFs. Acquisition time can be reduced by a factor of 4 (USF = 7.2), while image quality is still similar to a nearly fully sampled (USF = 1.8)gridding reconstructed data set. Conclusion: Especially for high USFs, the proposed algorithm allows improved image quality for multi-channel 23 Na MRI data sets.
CRIS-Team Scopus Importer:2019-05-14
Keywords: 7 Tesla; Compressed sensing (CS); Iterative reconstruction; Multi-channel; Prior knowledge; Sodium (

Computational hydrodynamics of a typical 3-fin surfboard setup - Falk, Sebastian; Kniesburges, Stefan; Janka, Rolf Matthias; Grosso, Roberto; Becker, Stefan; Semmler, Marion; Döllinger, Michael (Journal of Fluids and Structures, 2019)
Surfing is becoming increasingly popular, and the economic market for surfing products is growing. The performance of the surfboards and the fins has evolved continuously through the experience and innovative spirit of surfers and shapers. However, provided performance characteristics are only subjective and of descriptive nature. Therefore, we apply and analyze objective performance indicators as (1) lift and drag coefficient for each fin and the entire configuration and (2) lift-to-drag ratio for the entire fin configuration. This numerical study investigated a commercial 3-fin configuration, mounted into a rectangular simulation region, considering the flow at several different angles of attack between 0°and 45°. RANS and URANS simulations were performed with the SST k−ω turbulence model at an inflow velocity of 5 m/s. Simulation results showed that the fins have an optimal range of attack angles where they produce the most lift. The lift forces generate a turning moment which forces the board to be turned in direction to the shore favoring the controllability and stability of the surfboard. The higher the angle of attack, the higher is the drag coefficient. Lift-to-drag ratio values showed that for speeding up small attack angles with low drag forces are preferable. Furthermore, unsteady effects as flow separation combined with vortex shedding occur at high angles of attack above 20°which can only be resolved by URANS simulations. These unsteady effects have high negative influences on stability due to high fluctuation amplitudes for lift and drag forces. In summary, this study presents, to the best of the authors’ knowledge, for the first time, steady and unsteady forces on surfboard fins and discusses their potential influences on the surfer's controllability and stability of the surfboard during typical surfing maneuvers.
CRIS-Team Scopus Importer:2019-08-02
Keywords: Computational fluid dynamics (CFD); Fins; Hydrodynamics; STAR-CCM+; Surfboard; Surfing

Computed Tomography Angiography of Carotid Arteries and Vertebrobasilar System: A Simulation Study for Radiation Dose Reduction - Kramer, Manuel; Ellmann, Stephan; Allmendinger, Thomas; Eller, Achim; Kammerer, Ferdinand; May, Matthias; Baigger, Joao F.; Uder, Michael; Lell, Michael (Medicine, 2015)
Computed tomography angiography (CTA) of carotid arteries and vertebrobasilar system is a standardized procedure with excellent image quality, but radiation exposure remains a matter of concern. The aim of this study is to examine to what extent radiation dose can be lowered in relation to a standard protocol by simulating examinations with lower tube currents applying a dedicated software.Lower tube current was simulated by a dedicated noise insertion and reconstruction software (ReconCT). In a phantom study, true scans were performed with different dose protocols and compared to the results of simulated dose reductions of the same degree, respectively. In a patient study, 30 CTAs of supra-aortic vessels were reconstructed at a level of 100%, 75%, 50%, and 25% of the initial dose. Objective and subjective image analyses were performed.No significant noise differences between true scans and simulated scans of mimicked contrasted vessels were found. In the patient study, the quality scores of the 4 dose groups differed statistically significant; this difference vanished for the comparison of the 100% and 75% datasets after dichotomization into the categories of diagnostic and nondiagnostic image quality (P = .50).This study suggests an easy-to-implement method of simulating CTAs of carotid arteries and vertebrobasilar system with lower tube current for dose reduction by artificially adding noise to the original raw data. Lowering the radiation dose in a moderate extent to 75% of the original dose levels does not significantly alter the diagnostic image quality.
EVALuna2:14495

Computed Tomography-Guided Percutaneous Gastrostomy/Jejunostomy for Feeding and Decompression - Albrecht, Heinz; Hagel, Alexander; Schlechtweg, Philipp; Förtsch, Thomas; Neurath, Markus; Mudter, Jonas (Nutrition in Clinical Practice, 2017)
An effective method for long-term enteral feeding or stomach decompression is the use of a percutaneous gastrostomy (PEG) or sometimes jejunostomy (PEJ). Under certain circumstances (eg, inadequate transillumination), endoscopic placement of PEG/PEJ tubes is impossible. In these cases, computed tomography (CT)-guided PEG/PEJ may represent an alternative technique. In this study, we evaluate indications, results, and complications of CT-guided PEG/PEJ.A total of 102 consecutive referred patients were enrolled in the study. Patients came to the endoscopy unit of our department to undergo a CT-guided PEG/PEJ for long-term intragastric/intrajejunal feeding (n = 57) or decompression (n = 45). The majority (n = 98) received a pull-through PEG/PEJ with simultaneous gastroscopy/jejunoscopy. Dose length product and the effective dose for every patient were calculated.PEG/PEJ tube placement was successful in 87.3% (89 of 102). Feeding PEG/PEJ tube placement was successfully completed in 91.2% (52 of 57); decompressive PEG/PEJ tube placement was likewise successfully completed in 82.2% (37 of 45). No procedure-related mortality was observed. Minor complications (eg, tube dysfunction, local bleeding, minimal leakage, local skin infection) were observed in 13 patients. The complication rate was similar between the feeding and decompression groups ( P = .9).CT-guided PEG/PEJ is a feasible and safe method with a low procedure-related morbidity rate for patients where endoscopic placement via transillumination is not successful. Thus, the procedure is an attractive alternative to surgical tube placement. Long-term complications, mainly tube disturbances, can be treated easily.
EVALuna2:14587

Computed Tomography-Guided Wire-Marking for Thoracoscopic Resection of Small Lung Nodules in Children - Seitz, Sigurd T.; Schellerer, Vera; Schmid, Axel; Metzler, Markus; Besendörfer, Manuel (Journal of Laparoendoscopic & Advanced Surgical Techniques, 2019)
Introduction: In pediatric patients, thoracoscopic wedge-resection of pulmonary nodules is an established therapy. However, intraoperative localization of small lesions is still challenging. Purpose of this study was to evaluate the efficacy of preoperative computed tomography (CT)-guided wire-marking of small lung nodules. Materials and Methods: Between 2012 and 2017 a total of six cases receiving thoracoscopic resection of CT-marked lung nodules were analyzed. The nodules were preoperatively tagged by a wire, which was attached to the thoracic wall by sterile dressing. Characteristics of interest were stability of wire, complete resection, and prevention of open thoracotomy. Results: Six procedures were performed on five patients, including four men and one woman. Median age at intervention was 16 years (range 11-19 years). All patients had a history of primary malignancies, including osteosarcoma (n = 4) and synovial sarcoma (n = 1). A total of 10 nodules were visualized in CT of which 9 were marked by wire. The median expected size of nodules was 6 mm (range 2-23 mm). Two patients had bilateral, two left-sided and two right-sided lung lesions. There was no wire slippage. In five procedures wedge resection was possible; one case needed a near total lobe resection. In one case a mini-thoracotomy at port insertion site was performed to extract the specimen. There was no conversion to thoracotomy. Histopathology showed R0 resection in all patients. Malignancy was found in all specimens. In one patient postoperative hemorrhagic anemia necessitated transfusion. Conclusions: Preoperative wire-localization of small lung nodules is a safe and effective tool to enable thoracoscopic resection in children and to avoid thoracotomic interventions.
CRIS-Team WoS Importer:2019-04-18

Computed Tomography of the Head and Neck Region for Tumor Staging-Comparison of Dual-Source, Dual-Energy and Low-Kilovolt, Single-Energy Acquisitions - May, Matthias; Brügel, Joscha; Brand, Michael; Wiesmüller, Marco; Krauss, Bernhard; Allmendinger, Thomas; Uder, Michael; Wüst, Wolfgang (Investigative Radiology, 2017)
The aim of this study was to intra-individually compare the image quality obtained by dual-source, dual-energy (DSDE) computed tomography (CT) examinations and different virtual monoenergetic reconstructions to a low single-energy (SE) scan.Third-generation DSDE-CT was performed in 49 patients with histologically proven malignant disease of the head and neck region. Weighted average images (WAIs) and virtual monoenergetic images (VMIs) for low (40 and 60 keV) and high (120 and 190 keV) energies were reconstructed. A second scan aligned to the jaw, covering the oral cavity, was performed for every patient to reduce artifacts caused by dental hardware using a SE-CT protocol with 70-kV tube voltages and matching radiation dose settings. Objective image quality was evaluated by calculating contrast-to-noise ratios. Subjective image quality was evaluated by experienced radiologists.Highest contrast-to-noise ratios for vessel and tumor attenuation were obtained in 40-keV VMI (all P < 0.05). Comparable objective results were found in 60-keV VMI, WAI, and the 70-kV SE examinations. Overall subjective image quality was also highest for 40-keV, but differences to 60-keV VMI, WAI, and 70-kV SE were nonsignificant (all P > 0.05). High kiloelectron volt VMIs reduce metal artifacts with only limited diagnostic impact because of insufficiency in case of severe dental hardware. CTDIvol did not differ significantly between both examination protocols (DSDE: 18.6 mGy; 70-kV SE: 19.4 mGy; P = 0.10).High overall image quality for tumor delineation in head and neck imaging were obtained with 40-keV VMI. However, 70-kV SE examinations are an alternative and modified projections aligned to the jaw are recommended in case of severe artifacts caused by dental hardware.
EVALuna2:14672

Computer-aided assessment of anomalies in the scoliotic spine in 3-D MRI images - Jäger, Florian; Hornegger, Joachim; Schwab, Siegfried; Janka, Rolf Matthias (Springer-verlag, 2009)
The assessment of anomalies in the scoliotic spine using Magnetic Resonance Imaging (MRI) is an essential task during the planning phase of a patient's treatment and operations. Due to the pathologic bending of the spine, this is an extremely time consuming process as an orthogonal view onto every vertebra is required. In this article we present a system for computer-aided assessment (CAA) of anomalies in 3-D MRI images of the spine relying on curved planar reformations (CPR). We introduce all necessary steps, from the pre-processing of the data to the visualization component. As the core part of the framework is based on a segmentation of the spinal cord we focus on this. The proposed segmentation method is an iterative process. In every iteration the segmentation is updated by an energy based scheme derived from Markov random field (MRF) theory. We evaluate the segmentation results on public available clinical relevant 3-D MRI data sets of scoliosis patients. In order to assess the quality of the segmentation we use the angle between automatically computed planes through the vertebra and planes estimated by medical experts. This results in a mean angle difference of less than six degrees. © 2009 Springer-Verlag.

Computer-Aided Assessment of Anomalies in the Scoliotic Spine in 3-D MRI Images - Jäger, Florian; Hornegger, Joachim; Schwab, Siegfried; Janka, Rolf Matthias (Medical Image Computing and Computer-Assisted Intervention - MICCAI 2009, 12th International Conference, London, UK, September 20-24, 2009, Proceedings, Part II, 2009)
The assessment of anomalies in the scoliotic spine using Magnetic Resonance Imaging (MRI) is an essential task during the planning phase of a patient's treatment and operations. Due to the pathologic bending of the spine, this is an extremely time consuming process as an orthogonal view onto every vertebra is required. In this article we present a system for computer-aided assessment (CAA) of anomalies in 3-D MRI images of the spine relying on curved planar reformations (CPR). We introduce all necessary steps, from the pre-processing of the data to the visualization component. As the core part of the framework is based on a segmentation of the spinal cord we focus on this. The proposed segmentation method is an iterative process. In every iteration the segmentation is updated by an energy based scheme derived from Markov random field (MRF) theory. We evaluate the segmentation results on public available clinical relevant 3-D MRI data sets of scoliosis patients. In order to assess the quality of the segmentation we use the angle between automatically computed planes through the vertebra and planes estimated by medical experts. This results in a mean angle difference of less than six degrees.
UnivIS-Import:2015-04-16:Pub.2009.tech.IMMD.IMMD5.comput_4

Computer-aided diagnosis in multiparametric mri of the prostate: An open-access online tool for lesion classification with high accuracy - Ellmann, Stephan; Schlicht, Michael; Dietzel, Matthias; Janka, Rolf Matthias; Hammon, Matthias; Saake, Marc; Ganslandt, Thomas; Hartmann, Arndt; Kunath, Frank; Wullich, Bernd; Uder, Michael; Bäuerle, Tobias (Cancers, 2020)
Computer-aided diagnosis (CADx) approaches could help to objectify reporting on prostate mpMRI, but their use in many cases is hampered due to common-built algorithms that are not publicly available. The aim of this study was to develop an open-access CADx algorithm with high accuracy for classification of suspicious lesions in mpMRI of the prostate. This retrospective study was approved by the local ethics commission, with waiver of informed consent. A total of 124 patients with 195 reported lesions were included. All patients received mpMRI of the prostate between 2014 and 2017, and transrectal ultrasound (TRUS)-guided and targeted biopsy within a time period of 30 days. Histopathology of the biopsy cores served as a standard of reference. Acquired imaging parameters included the size of the lesion, signal intensity (T2w images), diffusion restriction, prostate volume, and several dynamic parameters along with the clinical parameters patient age and serum PSA level. Inter-reader agreement of the imaging parameters was assessed by calculating intraclass correlation coefficients. The dataset was stratified into a train set and test set (156 and 39 lesions in 100 and 24 patients, respectively). Using the above parameters, a CADx based on an Extreme Gradient Boosting algorithm was developed on the train set, and tested on the test set. Performance optimization was focused on maximizing the area under the Receiver Operating Characteristic curve (ROCAUC). The algorithm was made publicly available on the internet. The CADx reached an ROCAUC of 0.908 during training, and 0.913 during testing (p = 0.93). Additionally, established rule-in and rule-out criteria allowed classifying 35.8% of the malignant and 49.4% of the benign lesions with error rates of <2%. All imaging parameters featured excellent inter-reader agreement. This study presents an open-access CADx for classification of suspicious lesions in mpMRI of the prostate with high accuracy. Applying the provided rule-in and rule-out criteria might facilitate to further stratify the management of patients at risk.
CRIS-Team Scopus Importer:2020-09-18
Keywords: Artificial intelligence; Computer-aided diagnosis; Machine learning; Prostate cancer; Prostate mpMRI

Computer-aided evaluation of low-dose and low-contrast agent third-generation dual-source CT angiography prior to transcatheter aortic valve implantation (TAVI) - Dankerl, Peter; Hammon, Matthias; Seuß, Hannes; Tröbs, Monique; Schuhbaeck, Annika; Hell, Michaela M.; Achenbach, Stephan; Uder, Michael; Marwan, Mohamed; Cavallaro, Alexander Josef (International Journal of Computer Assisted Radiology and Surgery, 2016)
To evaluate the performance of computer-aided evaluation software for a comprehensive workup of patients prior to transcatheter aortic valve implantation (TAVI) using low-contrast agent and low radiation dose third-generation dual-source CT angiography.We evaluated 30 consecutive patients scheduled for TAVI. All patients underwent ECG-triggered high-pitch dual-source CT angiography of the aortic root and aorta with a standardized contrast agent volume (30 ml Imeron350, flow rate 4 ml/s) and low-dose (100 kv/350 mAs) protocol. An expert (10 years of experience) manually evaluated aortic root and iliac access dimensions (distance between coronary ostia and aortic annulus, minimal/maximal diameters and area-derived diameter of the aortic annulus) and best CT-predicted fluoroscopic projection angle as the reference standard. Utilizing computer-aided software (syngo.via), the same pre-TAVI workup was performed and compared to the reference standard.Mean CTDI[Formula: see text] was 3.46 mGy and mean DLP 217.6 ± 12.1 mGy cm, corresponding to a mean effective dose of 3.7 ± 0.2 mSv. Computer-aided evaluation was successful in all but one patient. Compared to the reference standard, Bland-Altman analysis indicated very good agreement for the distances between aortic annulus and coronary ostia (RCA: mean difference 0.8 mm; 95 % CI 0.4-1.2 mm; LM: mean difference 0.9 mm; 95 % CI 0.5-1.3 mm); however, we demonstrated a systematic overestimation of annulus- derived diameter using the software (mean difference 44.4 mm[Formula: see text]; 95 % CI 30.4-58.3 mm[Formula: see text]). Based on respective annulus dimensions, the recommended prosthesis size (Edwards SAPIEN 3) matched in 26 out of the 29 patients (90 %). CT-derived fluoroscopic projection angles showed an excellent agreement for both methods. Out of 58 iliac arteries, 15 (25 %) arteries could not be segmented by the software. Preprocessing time of the software was 71 ± 11 s (range 51-96 s), and reading time with the software was 118 ± 31 s (range 68-201 s).In the workup of pre-TAVI CT angiography, computer-aided evaluation of low-contrast, low-dose examinations is feasible with good agreement and quick reading time. However, a systematic overestimation of the aortic annulus area is observed.
EVALuna2:14602